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Sample records for robotic image-guided stereotactic

  1. Robotic Image-Guided Stereotactic Radiotherapy, for Isolated Recurrent Primary, Lymph Node or Metastatic Prostate Cancer

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    Jereczek-Fossa, Barbara Alicja, E-mail: barbara.jereczek@ieo.it [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); University of Milan, Milan (Italy); Beltramo, Giancarlo [CyberKnife Center CDI, Milan (Italy); Fariselli, Laura [Radiotherapy Unit, Carlo Besta Neurological Institute Foundation, Milan (Italy); Fodor, Cristiana [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); Santoro, Luigi [Department of Epidemiology and Statistics, European Institute of Oncology, Milan (Italy); Vavassori, Andrea; Zerini, Dario [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); Gherardi, Federica [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); University of Milan, Milan (Italy); Ascione, Carmen [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); Seconda Universita degli Studi di Napoli, Naples (Italy); Bossi-Zanetti, Isa; Mauro, Roberta [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); University of Milan, Milan (Italy); Bregantin, Achille; Bianchi, Livia Corinna [CyberKnife Center CDI, Milan (Italy); De Cobelli, Ottavio [Department of Urology, European Institute of Oncology, Milan (Italy); Orecchia, Roberto [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); University of Milan, Milan (Italy)

    2012-02-01

    Purpose: To evaluate the outcome of robotic CyberKnife (Accuray, Sunnyvale, CA)-based stereotactic radiotherapy (CBK-SRT) for isolated recurrent primary, lymph node, or metastatic prostate cancer. Methods and Materials: Between May 2007 and December 2009, 34 consecutive patients/38 lesions were treated (15 patients reirradiated for local recurrence [P], 4 patients reirradiated for anastomosis recurrence [A], 16 patients treated for single lymph node recurrence [LN], and 3 patients treated for single metastasis [M]). In all but 4 patients, [{sup 11}C]choline positron emission tomography/computed tomography was performed. CBK-SRT consisted of reirradiation and first radiotherapy in 27 and 11 lesions, respectively. The median CBK-SRT dose was 30 Gy in 4.5 fractions (P, 30 Gy in 5 fractions; A, 30 Gy in 5 fractions; LN, 33 Gy in 3 fractions; and M, 36 Gy in 3 fractions). In 18 patients (21 lesions) androgen deprivation was added to CBK-SRT (median duration, 16.6 months). Results: The median follow-up was 16.9 months. Acute toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event). Late toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event and 1 Grade 2 event). Biochemical response was observed in 32 of 38 evaluable lesions. Prostate-specific antigen stabilization was seen for 4 lesions, and in 2 cases prostate-specific antigen progression was reported. The 30-month progression-free survival rate was 42.6%. Disease progression was observed for 14 lesions (5, 2, 5, and 2 in Groups P, A, LN, and M respectively). In only 3 cases, in-field progression was seen. At the time of analysis (May 2010), 19 patients are alive with no evidence of disease and 15 are alive with disease. Conclusions: CyberKnife-based stereotactic radiotherapy is a feasible approach for isolated recurrent primary, lymph node, or metastatic prostate cancer, offering excellent in-field tumor

  2. CyberKnife robotic image-guided stereotactic radiotherapy for oligometastic cancer. A prospective evaluation of 95 patients/118 lesions

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    Jereczek-Fossa, B.A.; Bossi-Zanetti, I.; Mauro, R. [European Institute of Oncology, Milan (Italy). Dept. of Radiotherapy; Milan Univ. (Italy); Beltramo, G.; Bianchi, L.C. [CyberKnife Center CDI, Milan (Italy); Fariselli, L. [Carlo Besta Neurological Institute Foundation, Milan (Italy). Radiotherapy Unit; Fodor, C. [European Institute of Oncology, Milan (Italy). Dept. of Radiotherapy; Fossati, P.; Orecchia, R. [European Institute of Oncology, Milan (Italy). Dept. of Radiotherapy; National Center for Oncological Hadrontherapy (CNAO) Foundation, Pavia, Milan (Italy); Milan Univ. (Italy); Baroni, G. [National Center for Oncological Hadrontherapy (CNAO) Foundation, Pavia, Milan (Italy); Politecnico di Milano (Italy). Dept. of Bioengineering

    2013-06-15

    Purpose: To evaluate the outcome of robotic CyberKnife (Accuray Inc. Sunnyvale, USA)-based stereotactic radiotherapy (CBK-SRT) for oligometastic cancer patients. Patients and methods: Between May 2007 and December 2009, 95 patients with a total of 118 lesions underwent CBK-SRT (median dose 24 Gy in 3 fractions). Inclusion criteria: adult patients with limited volume cancer; suitability for SRT but not for other local therapies. Primary diagnoses included breast, lung, head and neck, gastrointestinal and other malignancies. Prostate cancer patients were excluded. Concomitant systemic therapy was given in 40 % of cases and median follow-up was 12 months. Toxicity and tumor response were evaluated using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) Scale and Response Evaluation Criteria in Solid Tumors RECIST. Results: Toxicity was rare and observed mainly in patients with comorbidities or uncontrolled cancer. Out of 87 evaluable lesions, complete radiological response, partial response, stabilization and progressive disease were observed in 15 (17 %), 25 (29 %), 34 (39 %) and 13 (15 %) lesions, respectively. Upon restricting the analysis to lesions treated with CBK-SRT alone (no concomitant therapy), response- and local control (LC) rates remained similar. Actuarial 3-year in-field progression-free survival- (i.e. LC), progression-free survival- (PFS) and overall-survival (OS) rates were 67.6, 18.4, and 31.2 %, respectively. LC was reduced in cases of early recurrence. OS- and cause-specific survival (CSS) rates were significantly lower in patients treated for visceral lesions. Failures were predominantly out-field. Conclusion: CBK-SRT is a feasible therapeutic approach for oligometastastic cancer patients that provides long-term in-field tumor control with a low toxicity profile. Further investigations should focus on dose escalation and optimization of the combination with systemic therapies. (orig.)

  3. Performance evaluation of a CyberKnife® G4 image-guided robotic stereotactic radiosurgery system

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    Antypas, Christos; Pantelis, Evaggelos

    2008-09-01

    The aim of the current work was to present the performance evaluation procedures implemented at our department for the commissioning of a G4 CyberKnife system. This system consists of a robotic manipulator, a target-locating system and a lightweight 6-MV linac. Individual quality assurance procedures were performed for each of the CyberKnife subsystems. The system was checked for the mechanical accuracy of its robotic manipulator. The performance of the target-locating system was evaluated in terms of mechanical accuracy of both cameras' alignment and quality assurance tests of the x-ray generators and the flat-panel detectors. The traditional linac 6-MV beam characteristics and beam output parameters were also measured. Results revealed a manipulator mechanical mean accuracy of ~0.1 mm, with individual maximum position uncertainties less than 0.25 mm. The target-locating system mechanical accuracy was found within the acceptance limits. For the most clinically used parameters in the CyberKnife practice, e.g. 100-120 kV and 50-200 ms, kV and exposure time accuracy error were measured as less than 2%, while the precision error of the kV was determined as less than 1%. The acquired images of the ETR grid pattern revealed no geometrical distortion while the critical frequency f50 values for cameras A and B were calculated as 1.5 lp mm-1 and 1.4 lp mm-1, respectively. Dose placement measurements were performed in a head and neck phantom. Results revealed sub-millimeter beam delivery precision whereas the total clinical accuracy of the system was measured equal to 0.44 ± 0.12 mm, 0.29 ± 0.10 mm and 0.53 ± 0.16 mm for the skull, fiducial and Xsight spine tracking methods, respectively. The results of this work certify the G4 CyberKnife SRS system capable of delivering high dose distributions with sub-millimeter accuracy and precision to intracranial and extracranial lesions. Moreover, total clinical accuracy of the investigated G4 system was found to be improved for

  4. Performance evaluation of a CyberKnife (registered) G4 image-guided robotic stereotactic radiosurgery system

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    Antypas, Christos; Pantelis, Evaggelos [Medical Physics Department, Iatropolis, Magnitiki Tomografia, Clinic and Diagnostic Center, Ethnikis Antistaseos 54-56, 15231 Athens (Greece)], E-mail: cantypas@med.uoa.gr

    2008-09-07

    The aim of the current work was to present the performance evaluation procedures implemented at our department for the commissioning of a G4 CyberKnife system. This system consists of a robotic manipulator, a target-locating system and a lightweight 6-MV linac. Individual quality assurance procedures were performed for each of the CyberKnife subsystems. The system was checked for the mechanical accuracy of its robotic manipulator. The performance of the target-locating system was evaluated in terms of mechanical accuracy of both cameras' alignment and quality assurance tests of the x-ray generators and the flat-panel detectors. The traditional linac 6-MV beam characteristics and beam output parameters were also measured. Results revealed a manipulator mechanical mean accuracy of {approx}0.1 mm, with individual maximum position uncertainties less than 0.25 mm. The target-locating system mechanical accuracy was found within the acceptance limits. For the most clinically used parameters in the CyberKnife practice, e.g. 100-120 kV and 50-200 ms, kV and exposure time accuracy error were measured as less than 2%, while the precision error of the kV was determined as less than 1%. The acquired images of the ETR grid pattern revealed no geometrical distortion while the critical frequency f{sub 50} values for cameras A and B were calculated as 1.5 lp mm{sup -1} and 1.4 lp mm{sup -1}, respectively. Dose placement measurements were performed in a head and neck phantom. Results revealed sub-millimeter beam delivery precision whereas the total clinical accuracy of the system was measured equal to 0.44 {+-} 0.12 mm, 0.29 {+-} 0.10 mm and 0.53 {+-} 0.16 mm for the skull, fiducial and Xsight spine tracking methods, respectively. The results of this work certify the G4 CyberKnife SRS system capable of delivering high dose distributions with sub-millimeter accuracy and precision to intracranial and extracranial lesions. Moreover, total clinical accuracy of the investigated G4

  5. Image guided robotic surgery: Current evidence for effectiveness in urology

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    Anum Pervez

    2014-12-01

    Full Text Available Objectives: Discussion of the evolution of image guided surgery (IGS and its fundamental components and current evidence for effectiveness of IGS in clinical urology. Methods: Literature search for image-guided robotic urology. Results: Current literature in image-guided robotic urology with its use in robot assisted radical prostatectomy and robot assisted partial nephrectomy are shown. Conclusions: Image guided surgery can be a useful aid to improve visualisation of anatomy and subsurface structures during minimally invasive surgery. Soft-tissue deformation makes it difficult to implement IGS in urology but current studies have shown an attempt to address this issue. The feasibility of IGS requires randomised control trials assessing in particular its accuracy and affect on clinical outcome.

  6. Robotic image-guided needle interventions of the prostate.

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    Mozer, Pierre C; Partin, Alan W; Stoianovici, Dan

    2009-01-01

    Prostate biopsy and needle-directed prostate therapies are currently performed free-handed or with needle external templates under ultrasound guidance. Direct image-guided intervention robots are modern instruments that have the potential to substantially enhance these procedures. These may increase the accuracy and repeatability with which needles are placed in the gland. The authors' group has developed a robot for precise prostate targeting that operates remotely alongside the patient in the magnetic resonance imaging scanner, as guided according to the image.

  7. Effect of image-guided hypofractionated stereotactic radiotherapy on peripheral non-small-cell lung cancer

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    Wang, Shu-wen; Ren, Juan; Yan, Yan-li; Xue, Chao-fan; Tan, Li; Ma, Xiao-wei

    2016-01-01

    The objective of this study was to compare the effects of image-guided hypofractionated radiotherapy and conventional fractionated radiotherapy on non-small-cell lung cancer (NSCLC). Fifty stage- and age-matched cases with NSCLC were randomly divided into two groups (A and B). There were 23 cases in group A and 27 cases in group B. Image-guided radiotherapy (IGRT) and stereotactic radiotherapy were conjugately applied to the patients in group A. Group A patients underwent hypofractionated radiotherapy (6–8 Gy/time) three times per week, with a total dose of 64–66 Gy; group B received conventional fractionated radiotherapy, with a total dose of 68–70 Gy five times per week. In group A, 1-year and 2-year local failure survival rate and 1-year local failure-free survival rate were significantly higher than in group B (P0.05) were lower in group A than in group B. The overall survival rate of group A was significantly higher than that of group B (P=0.03), and the survival rate at 1 year was 87% vs 63%, (P0.05). Compared with conventional fractionated radiation therapy, image-guided hypofractionated stereotactic radiotherapy in NSCLC received better treatment efficacy and showed good tolerability. PMID:27574441

  8. Robotically-adjustable microstereotactic frames for image-guided neurosurgery

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    Kratchman, Louis B.; Fitzpatrick, J. Michael

    2013-03-01

    Stereotactic frames are a standard tool for neurosurgical targeting, but are uncomfortable for patients and obstruct the surgical field. Microstereotactic frames are more comfortable for patients, provide better access to the surgical site, and have grown in popularity as an alternative to traditional stereotactic devices. However, clinically available microstereotactic frames require either lengthy manufacturing delays or expensive image guidance systems. We introduce a robotically-adjusted, disposable microstereotactic frame for deep brain stimulation surgery that eliminates the drawbacks of existing microstereotactic frames. Our frame can be automatically adjusted in the operating room using a preoperative plan in less than five minutes. A validation study on phantoms shows that our approach provides a target positioning error of 0.14 mm, which exceeds the required accuracy for deep brain stimulation surgery.

  9. Image-guided localization accuracy of stereoscopic planar and volumetric imaging methods for stereotactic radiation surgery and stereotactic body radiation therapy: a phantom study.

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    Kim, Jinkoo; Jin, Jian-Yue; Walls, Nicole; Nurushev, Teamour; Movsas, Benjamin; Chetty, Indrin J; Ryu, Samuel

    2011-04-01

    To evaluate the positioning accuracies of two image-guided localization systems, ExacTrac and On-Board Imager (OBI), in a stereotactic treatment unit. An anthropomorphic pelvis phantom with eight internal metal markers (BBs) was used. The center of one BB was set as plan isocenter. The phantom was set up on a treatment table with various initial setup errors. Then, the errors were corrected using each of the investigated systems. The residual errors were measured with respect to the radiation isocenter using orthogonal portal images with field size 3 × 3 cm(2). The angular localization discrepancies of the two systems and the correction accuracy of the robotic couch were also studied. A pair of pre- and post-cone beam computed tomography (CBCT) images was acquired for each angular correction. Then, the correction errors were estimated by using the internal BBs through fiducial marker-based registrations. The isocenter localization errors (μ ±σ) in the left/right, posterior/anterior, and superior/inferior directions were, respectively, -0.2 ± 0.2 mm, -0.8 ± 0.2 mm, and -0.8 ± 0.4 mm for ExacTrac, and 0.5 ± 0.7 mm, 0.6 ± 0.5 mm, and 0.0 ± 0.5 mm for OBI CBCT. The registration angular discrepancy was 0.1 ± 0.2° between the two systems, and the maximum angle correction error of the robotic couch was 0.2° about all axes. Both the ExacTrac and the OBI CBCT systems showed approximately 1 mm isocenter localization accuracies. The angular discrepancy of two systems was minimal, and the robotic couch angle correction was accurate. These positioning uncertainties should be taken as a lower bound because the results were based on a rigid dosimetry phantom. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results

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    Castelain Bernard

    2011-06-01

    Full Text Available Abstract Background The first-line treatment of a pelvic recurrence in a previously irradiated area is surgery. Unfortunately, few patients are deemed operable, often due to the location of the recurrence, usually too close to the iliac vessels, or the associated surgical morbidity. The objective of this study is to test the viability of robotic image-guided radiotherapy as an alternative treatment in inoperable cases. Methods Sixteen patients previously treated with radiotherapy were reirradiated with CyberKnife® for lateral pelvic lesions. Recurrences of primary rectal cancer (4 patients, anal canal (6, uterine cervix cancer (4, endometrial cancer (1, and bladder carcinoma (1 were treated. The median dose of the previous treatment was 45 Gy (EqD2 range: 20 to 96 Gy. A total dose of 36 Gy in six fractions was delivered with the CyberKnife over three weeks. The responses were evaluated according to RECIST criteria. Results Median follow-up was 10.6 months (1.9 to 20.5 months. The actuarial local control rate was 51.4% at one year. Median disease-free survival was 8.3 months after CyberKnife treatment. The actuarial one-year survival rate was 46%. Acute tolerance was limited to digestive grade 1 and 2 toxicities. Conclusions Robotic stereotactic radiotherapy can offer a short and well-tolerated treatment for lateral pelvic recurrences in previously irradiated areas in patients otherwise not treatable. Efficacy and toxicity need to be evaluated over the long term, but initial results are encouraging.

  11. Image-guided stereotactic radiotherapy for patients with vestibular schwannoma. A clinical study

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    Badakhshi, H.; Muellner, S.; Budach, V. [Charite School of Medicine and University Hospital of Berlin, Departments for Radiation Oncology, Berlin (Germany); Wiener, E. [School of Medicine and University Hospital of Berlin, Institute for Neuroradiology, Berlin (Germany)

    2014-06-15

    Local tumor control and functional outcome after linac-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for vestibular schwannoma (VS) were assessed. In all, 250 patients with VS were treated: 190 patients with tumors < 2 cm diameter underwent SRS and 60 patients with tumors >2 to 3.5 cm underwent FSRT. Dose prescription for all cases with SRS (n = 190, 76 %) was 13.5 Gy. For FSRT, mainly two hypofractionated schedules (n = 60, 24 %) with either 7 fractions of 5 Gy (total dose: 35 Gy; n = 35) or 11 fractions of 3.8 Gy (total dose: 41.8 Gy; n = 16) were used. The primary endpoint was local tumor control. Secondary endpoints were symptomatic control and morbidity. The median follow-up was 33.8 months. The 3-year local tumor control was 88.9 %. Local control for SRS and FSRT was 88 and 92 %, respectively. For FSRT with 35 and 41.8 Gy, local control was 90 and 100 %, respectively. There were no acute reactions exceeding grade I. In 61 cases (24.4 % of the entire cohort), trigeminal neuralgia was reported prior to treatment. At last follow-up, 16.3 % (10/61) of those patients reported relief of pain. Regarding facial nerve dysfunction, 45 patients (18 %) presented with symptoms prior to RT. At the last follow-up, 13.3% (6/45) of those patients reported a relief of dysesthesia. Using SRS to treat small VS results in good local control rates. FSRT for larger lesions also seems effective. Severe treatment-related complications are not frequent. Therefore, image-guided stereotactic radiotherapy is an appropriate alternative to microsurgery for patients with VS. (orig.) [German] Wir analysierten die lokale Kontrolle und die funktionellen Verlaeufe bei Patienten mit einem Vestibularisschwannom (VS), die sich einer linacbasierten stereotaktischen Radiochirurgie (SRS) oder einer fraktionierten stereotaktischen Radiotherapie (FSRT) unterzogen. Zwischen 1998 und 2008 wurden 250 Patienten mit einem VS behandelt. In dieser Kohorte wurden 190

  12. [Image guided and robotic treatment--the advance of cybernetics in clinical medicine].

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    Fosse, E; Elle, O J; Samset, E; Johansen, M; Røtnes, J S; Tønnessen, T I; Edwin, B

    2000-01-10

    The introduction of advanced technology in hospitals has changed the treatment practice towards more image guided and minimal invasive procedures. Modern computer and communication technology opens up for robot aided and pre-programmed intervention. Several robotic systems are in clinical use today both in microsurgery and in major cardiac and orthopedic operations. As this trend develops, professions which are new in this context such as physicists, mathematicians and cybernetic engineers will be increasingly important in the treatment of patients.

  13. Adjuvant therapy after resection of brain metastases. Frameless image-guided LINAC-based radiosurgery and stereotactic hypofractionated radiotherapy

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    Broemme, J.; Aebersold, D.M.; Pica, A. [Bern Univ., Bern Univ. Hospital (Switzerland). Dept. of Radiation Oncology; Abu-Isa, J.; Beck, J.; Raabe, A. [Bern Univ., Bern Univ. Hospital (Switzerland). Neurosurgery; Kottke, R.; Wiest, R. [Bern Univ., Bern Univ. Hospital (Switzerland). Neuroradiology; Malthaner, M.; Schmidhalter, D. [Bern Univ., Bern Univ. Hospital (Switzerland). Div. of Medical Radiation Physics

    2013-09-15

    Background: Tumor bed stereotactic radiosurgery (SRS) after resection of brain metastases is a new strategy to delay or avoid whole-brain irradiation (WBRT) and its associated toxicities. This retrospective study analyzes results of frameless image-guided linear accelerator (LINAC)-based SRS and stereotactic hypofractionated radiotherapy (SHRT) as adjuvant treatment without WBRT. Materials and methods: Between March 2009 and February 2012, 44 resection cavities in 42 patients were treated with SRS (23 cavities) or SHRT (21 cavities). All treatments were delivered using a stereotactic LINAC. All cavities were expanded by {>=} 2 mm in all directions to create the clinical target volume (CTV). Results: The median planning target volume (PTV) for SRS was 11.1 cm{sup 3}. The median dose prescribed to the PTV margin for SRS was 17 Gy. Median PTV for SHRT was 22.3 cm{sup 3}. The fractionation schemes applied were: 4 fractions of 6 Gy (5 patients), 6 fractions of 4 Gy (6 patients) and 10 fractions of 4 Gy (10 patients). Median follow-up was 9.6 months. Local control (LC) rates after 6 and 12 months were 91 and 77 %, respectively. No statistically significant differences in LC rates between SRS and SHRT treatments were observed. Distant brain control (DBC) rates at 6 and 12 months were 61 and 33 %, respectively. Overall survival (OS) at 6 and 12 months was 87 and 63.5 %, respectively, with a median OS of 15.9 months. One patient treated by SRS showed symptoms of radionecrosis, which was confirmed histologically. Conclusion: Frameless image-guided LINAC-based adjuvant SRS and SHRT are effective and well tolerated local treatment strategies after resection of brain metastases in patients with oligometastatic disease. (orig.)

  14. New real-time MR image-guided surgical robotic system for minimally invasive precision surgery

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    Hashizume, M.; Yasunaga, T.; Konishi, K. [Kyushu University, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Fukuoka (Japan); Tanoue, K.; Ieiri, S. [Kyushu University Hospital, Department of Advanced Medicine and Innovative Technology, Fukuoka (Japan); Kishi, K. [Hitachi Ltd, Mechanical Engineering Research Laboratory, Hitachinaka-Shi, Ibaraki (Japan); Nakamoto, H. [Hitachi Medical Corporation, Application Development Office, Kashiwa-Shi, Chiba (Japan); Ikeda, D. [Mizuho Ikakogyo Co. Ltd, Tokyo (Japan); Sakuma, I. [The University of Tokyo, Graduate School of Engineering, Bunkyo-Ku, Tokyo (Japan); Fujie, M. [Waseda University, Graduate School of Science and Engineering, Shinjuku-Ku, Tokyo (Japan); Dohi, T. [The University of Tokyo, Graduate School of Information Science and Technology, Bunkyo-Ku, Tokyo (Japan)

    2008-04-15

    To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D navigation and 2-D ISC images, as well as the MR-compatible laparoscope. The ISC image was updated every 4 s; no artifact was detected. A newly developed MR image-guided surgical robotic system is feasible for an operator to perform safe and precise minimally invasive procedures. (orig.)

  15. Versatility of the Novalis system to deliver image-guided stereotactic body radiation therapy (SBRT) for various anatomical sites.

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    Teh, Bin S; Paulino, Arnold C; Lu, Hsin H; Chiu, J Kam; Richardson, Susan; Chiang, Stephen; Amato, Robert; Butler, E Brian; Bloch, Charles

    2007-08-01

    Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) programs to treat brain tumors were implemented when we first acquired the Brainlab Novalis system in 2003. Two years later, we started an extra-cranial stereotactic radio-ablation or more appropriately a stereotactic body radiation therapy (SBRT) program using the Brainlab Novalis image-guided system at The Methodist Hospital in Houston, Texas. We hereby summarize our initial experience with this system in delivering image-guided SBRT to a total of 80 patients during our first year of clinical implementation, from February 2005 to January 2006. Over 100 lesions in more than 20 distinct anatomical sites were treated. These include all levels of spine from cervical, thoracic, lumbar, and sacral lesions. Spinal lesions encompass intramedullary, intradural, extradural, or osseous compartments. Also treated were lesions in other bony sites including orbit, clavicle, scapula, humerus, sternum, rib, femur, and pelvis (ilium, ischium, and pubis). Primary or metastatic lesions located in the head and neck, supraclavicular region, axilla, mediastinum, lung (both central and peripheral), abdominal wall, liver, kidney, para-aortic lymph nodes, prostate, and pelvis were also treated. In addition to primary radiotherapy, SBRT program using the Brainlab Novalis system allows re-irradiation for recurrence and "boost" after conventional treatment to various anatomical sites. Treating these sites safely and efficaciously requires knowledge in radiation tolerance, fraction size, total dose, biologically equivalent dose (BED), prior radiotherapy, detailed dose volume histograms (DVH) of normal tissues, and the radiosensitive/radioresistant nature of the tumor. Placement of radio-opaque markers (Visicoil, Radiomed) in anatomical sites not in close proximity to bony landmarks (e.g., kidney and liver) helps in measuring motion and providing image guidance during each treatment fraction. Tumor/organ motion

  16. An integrated multimodality image-guided robot system for small-animal imaging research

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    Hsu, Wen-Lin [Department of Radiology, Tzu-Chi University and Radiation Oncology, Buddhist Tzu-Chi General Hospital Hualien, Taiwan (China); Hsin Wu, Tung [Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan (China); Hsu, Shih-Ming [Department of Biomedical Imaging and Radiological Sciences, China Medical University, Taichung, Taiwan (China); Chen, Chia-Lin [Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan (China); Lee, Jason J.S., E-mail: jslee@ym.edu.tw [Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan (China); Huang, Yung-Hui, E-mail: yhhuang@isu.edu.tw [Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan (China)

    2011-10-01

    We design and construct an image-guided robot system for use in small-animal imaging research. This device allows the use of co-registered small-animal PET-MRI images to guide the movements of robotic controllers, which will accurately place a needle probe at any predetermined location inside, for example, a mouse tumor, for biological readouts without sacrificing the animal. This system is composed of three major components: an automated robot device, a CCD monitoring mechanism, and a multimodality registration implementation. Specifically, the CCD monitoring mechanism was used for correction and validation of the robot device. To demonstrate the value of the proposed system, we performed a tumor hypoxia study that involved FMISO small-animal PET imaging and the delivering of a pO{sub 2} probe into the mouse tumor using the image-guided robot system. During our evaluation, the needle positioning error was found to be within 0.153{+-}0.042 mm of desired placement; the phantom simulation errors were within 0.693{+-}0.128 mm. In small-animal studies, the pO{sub 2} probe measurements in the corresponding hypoxia areas showed good correlation with significant, low tissue oxygen tensions (less than 6 mmHg). We have confirmed the feasibility of the system and successfully applied it to small-animal investigations. The system could be easily adapted to extend to other biomedical investigations in the future.

  17. Image guided respiratory gated hypofractionated Stereotactic Body Radiation Therapy (H-SBRT) for liver and lung tumors: Initial experience

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    Wurm, R.E.; Gum, F.; Erbel, S. [Charite Campus Mitte, Berlin (Germany). Dept. of Radiation Oncology

    2006-09-15

    To evaluate our initial experience with image guided respiratory gated H-SBRT for liver and lung tumors. The system combines a stereoscopic x-ray imaging system (ExacTrac{sup R} X-Ray 6D) with a dedicated conformal stereotactic radiosurgery and radiotherapy linear accelerator (Novalis) and ExacTrac{sup R} Adaptive Gating for dynamic adaptive treatment. Moving targets are located and tracked by x-ray imaging of implanted fiducial markers defined in the treatment planning computed tomography (CT). The marker position is compared with the position in verification stereoscopic x-ray images, using fully automated marker detection software. The required shift for a correct, gated set-up is calculated and automatically applied. We present our acceptance testing and initial experience in patients with liver and lung tumors. For treatment planning CT and Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) as well as magnetic resonance imaging (MRI) taken at free breathing and expiration breath hold with internal and external fiducials present were used. Patients were treated with 8-11 consecutive fractions to a dose of 74.8-79.2 Gy. Phantom tests demonstrated targeting accuracy with a moving target to within {+-}1 mm. Inter- and intrafractional patient set-up displacements, as corrected by the gated set-up and not detectable by a conventional set-up, were up to 30 mm. Verification imaging to determine target location during treatment showed an average marker position deviation from the expected position of up to 4 mm on real patients. This initial evaluation shows the accuracy of the system and feasibility of image guided real-time respiratory gated H-SBRT for liver and lung tumors.

  18. VarioGuide: a new frameless image-guided stereotactic system--accuracy study and clinical assessment.

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    Ringel, Florian; Ingerl, Dominik; Ott, Stephanie; Meyer, Bernhard

    2009-05-01

    VarioGuide (BrainLAB AG, Feldkirchen, Germany) is a new system for frameless image-guided stereotaxy. In the present study, we aimed to assess target point accuracy in a laboratory setting and the clinical feasibility of the system. Using the phantom of our frame-based stereotactic system (Riechert-Mundinger; Inomed Medizintechnik GmbH, Teningen, Germany), target points were approached from different angles with the frameless system. Target point deviation in the x, y, and z planes was assessed. Furthermore, patients harboring intracranial lesions were diagnostically biopsied using VarioGuide. Phantom-based accuracy measurements yielded a mean target point deviation of 0.7 mm. Between February 2007 and April 2008, 27 patients were diagnostically biopsied. Lesion volumes ranged from 0.2 to 117.6 cm3, trajectory length ranged from 25.3 to 64.1 mm, and the diagnostic yield was 93%. Concluding from the phantom measurements with ideal image-object registration, assumed spherical lesions with a volume of 0.524 cm can be biopsied with 100% target localization. Early clinical data revealed VarioGuide to be safe and accurate for lesions of 0.2 cm3 and larger. Thereby, the system seems feasible for the biopsy of most intracranial lesions.

  19. [Setup accuracy of stereotactic body radiation therapy (SBRT) using virtual isocenter in image-guided radiation therapy (IGRT)].

    Science.gov (United States)

    Nakazawa, Hisato; Uchiyama, Yukio; Komori, Masataka; Hagiwara, Masahiro; Mori, Yoshimasa

    2012-01-01

    We use Novalis Body system for stereotactic body radiation therapy (SBRT) in lung and liver tumors. Novalis system is dedicated to SBRT with image-guided patient setup system ExacTrac. The spinal bone is the main landmark in patient setup during SBRT using ExacTrac kV X-ray system. When the target tumor is located laterally distant from the spinal bone at the midline, it is difficult to ensure the accuracy of the setup, especially if there are rotational gaps (yaw, pitch and roll) in the setup. For this, we resolve the problem by using a virtual isocenter (VIC) different from isocenter (IC) .We evaluated the setup accuracy in a rand phantom by using VIC and checked the setup errors using rand phantom and patient cases by our original method during the setup for IC. The accuracy of setup using VIC was less than 1.0 mm. Our original method was useful for checking patient setup when VIC used.

  20. [Assessment of overall spatial accuracy in image guided stereotactic body radiotherapy using a spine registration method].

    Science.gov (United States)

    Nakazawa, Hisato; Uchiyama, Yukio; Komori, Masataka; Hayashi, Naoki

    2014-06-01

    Stereotactic body radiotherapy (SBRT) for lung and liver tumors is always performed under image guidance, a technique used to confirm the accuracy of setup positioning by fusing planning digitally reconstructed radiographs with X-ray, fluoroscopic, or computed tomography (CT) images, using bony structures, tumor shadows, or metallic markers as landmarks. The Japanese SBRT guidelines state that bony spinal structures should be used as the main landmarks for patient setup. In this study, we used the Novalis system as a linear accelerator for SBRT of lung and liver tumors. The current study compared the differences between spine registration and target registration and calculated total spatial accuracy including setup uncertainty derived from our image registration results and the geometric uncertainty of the Novalis system. We were able to evaluate clearly whether overall spatial accuracy is achieved within a setup margin (SM) for planning target volume (PTV) in treatment planning. After being granted approval by the Hospital and University Ethics Committee, we retrospectively analyzed eleven patients with lung tumor and seven patients with liver tumor. The results showed the total spatial accuracy to be within a tolerable range for SM of treatment planning. We therefore regard our method to be suitable for image fusion involving 2-dimensional X-ray images during the treatment planning stage of SBRT for lung and liver tumors.

  1. Image-guided surgery and medical robotics in the cranial area.

    Science.gov (United States)

    Widmann, G

    2007-01-01

    Surgery in the cranial area includes complex anatomic situations with high-risk structures and high demands for functional and aesthetic results. Conventional surgery requires that the surgeon transfers complex anatomic and surgical planning information, using spatial sense and experience. The surgical procedure depends entirely on the manual skills of the operator. The development of image-guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. Augmented reality, mechatronic surgical tools, and medical robotics may continue to progress in surgical instrumentation, and ultimately, surgical care. The aim of this article is to review and discuss state-of-the-art surgical navigation and medical robotics, image-to-patient registration, aspects of accuracy, and clinical applications for surgery in the cranial area.

  2. Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures.

    Science.gov (United States)

    Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

    2017-08-16

    Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.

  3. Migration of implanted markers for image-guided lung tumor stereotactic ablative radiotherapy.

    Science.gov (United States)

    Hong, Julian C; Eclov, Neville C W; Yu, Yao; Rao, Aarti K; Dieterich, Sonja; Le, Quynh-Thu; Diehn, Maximilian; Sze, Daniel Y; Loo, Billy W; Kothary, Nishita; Maxim, Peter G

    2013-03-04

    The purpose of this study was to quantify postimplantation migration of percutaneously implanted cylindrical gold seeds ("seeds") and platinum endovascular embolization coils ("coils") for tumor tracking in pulmonary stereotactic ablative radiotherapy (SABR). We retrospectively analyzed the migration of markers in 32 consecutive patients with computed tomography scans postimplantation and at simulation. We implanted 147 markers (59 seeds, 88 coils) in or around 34 pulmonary tumors over 32 procedures, with one lesion implanted twice. Marker coordinates were rigidly aligned by minimizing fiducial registration error (FRE), the root mean square of the differences in marker locations for each tumor between scans. To also evaluate whether single markers were responsible for most migration, we aligned with and without the outlier causing the largest FRE increase per tumor. We applied the resultant transformation to all markers. We evaluated migration of individual markers and FRE of each group. Median scan interval was 8 days. Median individual marker migration was 1.28 mm (interquartile range [IQR] 0.78-2.63 mm). Median lesion FRE was 1.56 mm (IQR 0.92-2.95 mm). Outlier identification yielded 1.03 mm median migration (IQR 0.52-2.21 mm) and 1.97 mm median FRE (IQR 1.44-4.32 mm). Outliers caused a mean and median shift in the centroid of 1.22 and 0.80 mm (95th percentile 2.52 mm). Seeds and coils had no statistically significant difference. Univariate analysis suggested no correlation of migration with the number of markers, contact with the chest wall, or time elapsed. Marker migration between implantation and simulation is limited and unlikely to cause geometric miss during tracking.

  4. Reliability of EUCLIDIAN: an autonomous robotic system for image-guided prostate brachytherapy.

    Science.gov (United States)

    Podder, Tarun K; Buzurovic, Ivan; Huang, Ke; Showalter, Timothy; Dicker, Adam P; Yu, Yan

    2011-01-01

    Recently, several robotic systems have been developed to perform accurate and consistent image-guided brachytherapy. Before introducing a new device into clinical operations, it is important to assess the reliability and mean time before failure (MTBF) of the system. In this article, the authors present the preclinical evaluation and analysis of the reliability and MTBF of an autonomous robotic system, which is developed for prostate seed implantation. The authors have considered three steps that are important in reliability growth analysis. These steps are: Identification and isolation of failures, classification of failures, and trend analysis. For any one-of-a-kind product, the reliability enhancement is accomplished through test-fix-test. The authors have used failure mode and effect analysis for collection and analysis of reliability data by identifying and categorizing the failure modes. Failures were classified according to severity. Failures that occurred during the operation of this robotic system were considered as nonhomogenous Poisson process. The failure occurrence trend was analyzed using Laplace test. For analyzing and predicting reliability growth, commonly used and widely accepted models, Duane's model and the Army Material Systems Analysis Activity, i.e., Crow's model, were applied. The MTBF was used as an important measure for assessing the system's reliability. During preclinical testing, 3196 seeds (in 53 test cases) were deposited autonomously by the robot and 14 critical failures were encountered. The majority of the failures occurred during the first few cases. The distribution of failures followed Duane's postulation as well as Crow's postulation of reliability growth. The Laplace test index was -3.82 (robotic system. At 95% confidence, the reliability for deposition of 65 seeds was more than 90%. Analyses of failure mode strongly indicated a gradual improvement of reliability of this autonomous robotic system. High MTBF implied that

  5. An Ultrasound Imaging-Guided Robotic HIFU Ablation Experimental System and Accuracy Evaluations

    Directory of Open Access Journals (Sweden)

    Chih Yu An

    2017-01-01

    Full Text Available In recent years, noninvasive thermal treatment by using high-intensity focused ultrasound (HIFU has high potential in tumor treatment. The goal of this research is to develop an ultrasound imaging-guided robotic HIFU ablation system for tumor treatment. The system integrates the technologies of ultrasound image-assisted guidance, robotic positioning control, and HIFU treatment planning. With the assistance of ultrasound image guidance technology, the tumor size and location can be determined from ultrasound images as well as the robotic arm can be controlled to position the HIFU transducer to focus on the target tumor. After the development of the system, several experiments were conducted to measure the positioning accuracy of this system. The results show that the average positioning error is 1.01 mm with a standard deviation 0.34, and HIFU ablation accuracy is 1.32 mm with a standard deviation 0.58, which means this system is confirmed with its possibility and accuracy.

  6. Defining the Optimal Planning Target Volume in Image-Guided Stereotactic Radiosurgery of Brain Metastases: Results of a Randomized Trial

    Energy Technology Data Exchange (ETDEWEB)

    Kirkpatrick, John P., E-mail: john.kirkpatrick@dm.duke.edu [Department of Radiation Oncology, Duke University, Durham, North Carolina (United States); Department of Surgery, Duke University, Durham, North Carolina (United States); Wang, Zhiheng [Department of Radiation Oncology, Duke University, Durham, North Carolina (United States); Sampson, John H. [Department of Radiation Oncology, Duke University, Durham, North Carolina (United States); Department of Surgery, Duke University, Durham, North Carolina (United States); McSherry, Frances; Herndon, James E. [Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina (United States); Allen, Karen J.; Duffy, Eileen [Department of Radiation Oncology, Duke University, Durham, North Carolina (United States); Hoang, Jenny K. [Department of Radiology, Duke University, Durham, North Carolina (United States); Chang, Zheng; Yoo, David S.; Kelsey, Chris R.; Yin, Fang-Fang [Department of Radiation Oncology, Duke University, Durham, North Carolina (United States)

    2015-01-01

    Purpose: To identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence. Methods and Materials: Adult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board–approved trial. Individual lesions were randomized to 1- or 3- mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator–based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS). Results: Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non–small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P<.01), and GTV was similar (P=.76). At a median follow-up time of 32.2 months, 11 patients were alive, with median OS 10.6 months. LR was observed in only 3 lesions (2 in the 1 mm group, P=.51), with 6.7% LR 12 months after SRS. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3-mm group, P=.10). The 12-month DF rate was 45.7%. Three months after SRS, no significant change in

  7. Hypofractionated image-guided breath-hold SABR (Stereotactic Ablative Body Radiotherapy of liver metastases – clinical results

    Directory of Open Access Journals (Sweden)

    Boda-Heggemann Judit

    2012-06-01

    -reactive protein. Conclusions A trend to statistically significant correlation of local progression was observed for BED2 and PTV-size. Dose-levels BED2 > 78 Gy cannot be reached in large lesions constituting a significant fraction of this series. Image-guided SABR (igSABR is therefore an effective non-invasive treatment modality with low toxicity in patients with small inoperable liver metastases.

  8. Reliability of EUCLIDIAN: An autonomous robotic system for image-guided prostate brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Podder, Tarun K.; Buzurovic, Ivan; Huang Ke; Showalter, Timothy; Dicker, Adam P.; Yu, Yan [Department of Radiation Oncology, Kimmel Cancer Center (NCI-designated), Thomas Jefferson University, Philadelphia, Pennsylvania 19107 (United States)

    2011-01-15

    Purpose: Recently, several robotic systems have been developed to perform accurate and consistent image-guided brachytherapy. Before introducing a new device into clinical operations, it is important to assess the reliability and mean time before failure (MTBF) of the system. In this article, the authors present the preclinical evaluation and analysis of the reliability and MTBF of an autonomous robotic system, which is developed for prostate seed implantation. Methods: The authors have considered three steps that are important in reliability growth analysis. These steps are: Identification and isolation of failures, classification of failures, and trend analysis. For any one-of-a-kind product, the reliability enhancement is accomplished through test-fix-test. The authors have used failure mode and effect analysis for collection and analysis of reliability data by identifying and categorizing the failure modes. Failures were classified according to severity. Failures that occurred during the operation of this robotic system were considered as nonhomogenous Poisson process. The failure occurrence trend was analyzed using Laplace test. For analyzing and predicting reliability growth, commonly used and widely accepted models, Duane's model and the Army Material Systems Analysis Activity, i.e., Crow's model, were applied. The MTBF was used as an important measure for assessing the system's reliability. Results: During preclinical testing, 3196 seeds (in 53 test cases) were deposited autonomously by the robot and 14 critical failures were encountered. The majority of the failures occurred during the first few cases. The distribution of failures followed Duane's postulation as well as Crow's postulation of reliability growth. The Laplace test index was -3.82 (<0), indicating a significant trend in failure data, and the failure intervals lengthened gradually. The continuous increase in the failure occurrence interval suggested a trend toward

  9. 3D image-guided robotic needle positioning system for small animal interventions.

    Science.gov (United States)

    Bax, Jeffrey S; Waring, Christopher S R; Sherebrin, Shi; Stapleton, Shawn; Hudson, Thomas J; Jaffray, David A; Lacefield, James C; Fenster, Aaron

    2013-01-01

    of the targeting experiments were combined with the known calibration and needle deflection errors to provide a more meaningful measure of the needle positioning accuracy of the system. The combined targeting errors of the system were 149 ± 41 μm and 218 ± 38 μm using the primary and combined registrations, respectively. Finally, pilot in vivo experiments were successfully completed to demonstrate the performance of the system in a biomedical application. The device was able to achieve the desired performance with an error of <200 μm and improved repeatability when compared to other designs. The device expands the capabilities of image-guided interventions for preclinical biomedical applications.

  10. A novel virtual reality environment for preoperative planning and simulation of image guided intracardiac surgeries with robotic manipulators.

    Science.gov (United States)

    Yeniaras, Erol; Deng, Zhigang; Syed, Mushabbar A; Davies, Mark G; Tsekos, Nikolaos V

    2011-01-01

    The evolution of image-guided and robot-assisted procedures can be beneficial to intracardiac interventions. This paper proposes a novel approach and a virtual reality system for preoperative planning and intraoperative guidance of cardiac procedures, and for investigating the kinematics and control of a virtual robotic manipulator, based on MRI CINE images. The system incorporates dedicated software modules for processing MR images, generating dynamic trajectories in the continuously changing environment of a beating heart, controlling a specific generic virtual manipulator along those trajectories, and a virtual reality interface that fuses all those information. The proposed system is applied for the simulation of accessing the aortic valve annulus via a small incision on the apex by maneuvering a robotic manipulator through an access corridor that safely transverses the left ventricle (LV) of the beating heart.

  11. Hypofractionated stereotactic body radiotherapy for primary and metastatic liver tumors using the novalis image-guided system: preliminary results regarding efficacy and toxicity.

    Science.gov (United States)

    Iwata, Hiromitsu; Shibamoto, Yuta; Hashizume, Chisa; Mori, Yoshimasa; Kobayashi, Tatsuya; Hayashi, Naoki; Kosaki, Katsura; Ishikawa, Tetsuya; Kuzuya, Teiji; Utsunomiya, Setsuo

    2010-12-01

    www.tcrt.org The purpose of this study was to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) for primary and metastatic liver tumors using the Novalis image-guided radiotherapy system. After preliminarily treating liver tumors using the Novalis system from July 2006, we started a protocol-based study in February 2008. Eighteen patients (6 with primary hepatocellular carcinoma and 12 with metastatic liver tumor) were treated with 55 or 50 Gy, depending upon their planned dose distribution and liver function, delivered in 10 fractions over 2 weeks. Four non-coplanar and three coplanar static beams were used. Patient age ranged from 54 to 84 years (median: 72 years). The Child-Pugh classification was Grade A in 17 patients and Grade B in 1. Tumor diameter ranged from 12 to 35 mm (median: 23 mm). Toxicities were evaluated according to the Common Terminology Criteria of Adverse Events version 4.0, and radiation-induced liver disease (RILD) was defined by Lawrence's criterion. The median follow-up period was 14.5 months. For all patients, the 1-year overall survival and local control rates were 94% and 86%, respectively. A Grade 1 liver enzyme change was observed in 5 patients, but no RILD or chronic liver dysfunction was observed. SBRT using the Novalis image-guided system is safe and effective for treating primary and metastatic liver tumors. Further investigation of SBRT for liver tumors is warranted. In view of the acceptable toxicity observed with this protocol, we have moved to a new protocol to shorten the overall treatment time and escalate the dose.

  12. Three-dimensional ultrasound image-guided robotic system for accurate microwave coagulation of malignant liver tumours.

    Science.gov (United States)

    Xu, Jing; Jia, Zhen-zhong; Song, Zhang-jun; Yang, Xiang-dong; Chen, Ken; Liang, Ping

    2010-09-01

    The further application of conventional ultrasound (US) image-guided microwave (MW) ablation of liver cancer is often limited by two-dimensional (2D) imaging, inaccurate needle placement and the resulting skill requirement. The three-dimensional (3D) image-guided robotic-assisted system provides an appealing alternative option, enabling the physician to perform consistent, accurate therapy with improved treatment effectiveness. Our robotic system is constructed by integrating an imaging module, a needle-driven robot, a MW thermal field simulation module, and surgical navigation software in a practical and user-friendly manner. The robot executes precise needle placement based on the 3D model reconstructed from freehand-tracked 2D B-scans. A qualitative slice guidance method for fine registration is introduced to reduce the placement error caused by target motion. By incorporating the 3D MW specific absorption rate (SAR) model into the heat transfer equation, the MW thermal field simulation module determines the MW power level and the coagulation time for improved ablation therapy. Two types of wrists are developed for the robot: a 'remote centre of motion' (RCM) wrist and a non-RCM wrist, which is preferred in real applications. The needle placement accuracies were < 3 mm for both wrists in the mechanical phantom experiment. The target accuracy for the robot with the RCM wrist was improved to 1.6 +/- 1.0 mm when real-time 2D US feedback was used in the artificial-tissue phantom experiment. By using the slice guidance method, the robot with the non-RCM wrist achieved accuracy of 1.8 +/- 0.9 mm in the ex vivo experiment; even target motion was introduced. In the thermal field experiment, a 5.6% relative mean error was observed between the experimental coagulated neurosis volume and the simulation result. The proposed robotic system holds promise to enhance the clinical performance of percutaneous MW ablation of malignant liver tumours. Copyright 2010 John Wiley

  13. Intrafraction Variation of Mean Tumor Position During Image-Guided Hypofractionated Stereotactic Body Radiotherapy for Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Grills, Inga S., E-mail: igrills@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Kestin, Larry L.; McGrath, Samuel; Ye Hong; Martin, Shannon K.; Yan Di [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2012-04-01

    Purpose: Prolonged delivery times during daily cone-beam computed tomography (CBCT)-guided lung stereotactic body radiotherapy (SBRT) introduce concerns regarding intrafraction variation (IFV) of the mean target position (MTP). The purpose of this study was to evaluate the magnitude of the IFV-MTP and to assess target margins required to compensate for IFV and postonline CBCT correction residuals. Patient, treatment, and tumor characteristics were analyzed with respect to their impact on IFV-MTP. Methods and Materials: A total of 126 patients with 140 tumors underwent 659 fractions of lung SBRT. Dose prescribed was 48 or 60 Gy in 12 Gy fractions. Translational target position correction of the MTP was performed via onboard CBCT. IFV-MTP was measured as the difference in MTP between the postcorrection CBCT and the posttreatment CBCT excluding residual error. Results: IFV-MTP was 0.2 {+-} 1.8 mm, 0.1 {+-} 1.9 mm, and 0.01 {+-} 1.5 mm in the craniocaudal, anteroposterior, and mediolateral dimensions and the IFV-MTP vector was 2.3 {+-} 2.1 mm. Treatment time and excursion were found to be significant predictors of IFV-MTP. An IFV-MTP vector greater than 2 and 5 mm was seen in 40.8% and 7.2% of fractions, respectively. IFV-MTP greater than 2 mm was seen in heavier patients with larger excursions and longer treatment times. Significant differences in IFV-MTP were seen between immobilization devices. The stereotactic frame immobilization device was found to be significantly less likely to have an IFV-MTP vector greater than 2 mm compared with the alpha cradle, BodyFIX, and hybrid immobilization devices. Conclusions: Treatment time and respiratory excursion are significantly associated with IFV-MTP. Significant differences in IFV-MTP were found between immobilization devices. Target margins for IFV-MTP plus post-correction residuals are dependent on immobilization device with 5-mm uniform margins being acceptable for the frame immobilization device.

  14. FPGA-based High-Performance Collision Detection: An Enabling Technique for Image-Guided Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Zhaorui Zhang

    2016-08-01

    Full Text Available Collision detection, which refers to the computational problem of finding the relative placement or con-figuration of two or more objects, is an essential component of many applications in computer graphics and robotics. In image-guided robotic surgery, real-time collision detection is critical for preserving healthy anatomical structures during the surgical procedure. However, the computational complexity of the problem usually results in algorithms that operate at low speed. In this paper, we present a fast and accurate algorithm for collision detection between Oriented-Bounding-Boxes (OBBs that is suitable for real-time implementation. Our proposed Sweep and Prune algorithm can perform a preliminary filtering to reduce the number of objects that need to be tested by the classical Separating Axis Test algorithm, while the OBB pairs of interest are preserved. These OBB pairs are re-checked by the Separating Axis Test algorithm to obtain accurate overlapping status between them. To accelerate the execution, our Sweep and Prune algorithm is tailor-made for the proposed method. Meanwhile, a high performance scalable hardware architecture is proposed by analyzing the intrinsic parallelism of our algorithm, and is implemented on FPGA platform. Results show that our hardware design on the FPGA platform can achieve around 8X higher running speed than the software design on a CPU platform. As a result, the proposed algorithm can achieve a collision frame rate of 1 KHz, and fulfill the requirement for the medical surgery scenario of Robot Assisted Laparoscopy.

  15. Hazard analysis of EUCLIDIAN: an image-guided robotic brachytherapy system.

    Science.gov (United States)

    Hu, Yida; Podder, Tarun; Buzurovic, Ivan; Yan, Kaiguo; Ng, Wan Sing; Yu, Yan

    2007-01-01

    Robotic assistance can help clinicians to improve the flexibility of needle insertion and accuracy of seed deposition. However, the robotic platform is a safety critical system for its automated operational mode. Thus, it is important to perform Hazard Identification & Safety Insurance Control (HISIC) for securing the safety of a medical robotic system. In this paper, we have performed HISIC for our robotic platform, called Endo-Uro Computer Lattice for Intratumoral Delivery, Implementation, and Ablation with Nanosensing (ECLIDIAN). The definition and requirements of the system are described by Unified Modeling Language (UML). Failure Mode and Effect Analysis (FMEA) are executed for the principles of HISIC, such as hazard identification, safety insurance control, safety critical limit, monitoring and control. FMEA combined with UML can also be implemented to ensure reliability of the human operation. On the basis of safety control index and fuzzy mathematics, safety effective value is outlined to assess the validity of safety insurance control for robotic system. The above principles and methods are feasible and effective for hazard analysis during the development of the robotic system.

  16. The System Design and Evaluation of a 7-DOF Image-Guided Venipuncture Robot

    Science.gov (United States)

    Balter, Max L.; Chen, Alvin I.; Maguire, Timothy J.; Yarmush, Martin L.

    2015-01-01

    Accessing the venous bloodstream to deliver fluids or obtain a blood sample is the most common clinical routine practiced in the U.S. Practitioners continue to rely on manual venipuncture techniques, but success rates are heavily dependent on clinician skill and patient physiology. In the U.S., failure rates can be as high as 50% in difficult patients, making venipuncture the leading cause of medical injury. To improve the rate of first-stick success, we have developed a portable autonomous venipuncture device that robotically servos a needle into a suitable vein under image guidance. The device operates in real time, combining near-infrared and ultra-sound imaging, image analysis, and a 7-degree-of-freedom (DOF) robotic system to perform the venipuncture. The robot consists of a 3-DOF gantry to image the patient's peripheral forearm veins and a miniaturized 4-DOF serial arm to guide the cannula into the selected vein under closed-loop control. In this paper, we present the system architecture of the robot and evaluate the accuracy and precision through tracking, free-space positioning, and in vitro phantom cannulation experiments. The results demonstrate sub-millimeter accuracy throughout the operating workspace of the manipulator and a high rate of success when cannulating phantom veins in a skin-mimicking tissue model. PMID:26257588

  17. Towards image guided robotic surgery: multi-arm tracking through hybrid localization

    Energy Technology Data Exchange (ETDEWEB)

    Kwartowitz, David Morgan [Vanderbilt University, Department of Biomedical Engineering, Nashville, TN (United States); Mayo Clinic, Biomedical Imaging Resource, Rochester, MN (United States); Miga, Michael I. [Vanderbilt University, Department of Biomedical Engineering, Nashville, TN (United States); Herrell, S.D. [Vanderbilt University, Department of Urology, Nashville, TN (United States); Galloway, Robert L. [Vanderbilt University, Department of Biomedical Engineering, Nashville, TN (United States); Vanderbilt University, Department of Surgery, Nashville, TN (United States); Vanderbilt University, Department of Neurological Surgery, Nashville, TN (United States)

    2009-05-15

    Use of the robotic assisted surgery has been increasing in recent years, due both the continuous increase in the number of applications and the clinical benefits that surgical robots can provide. Currently robotic assisted surgery relies on endoscopic video for navigation, providing only surface visualization, thus limiting subsurface vision. To be able to visualize and identify subsurface information, techniques in image-guidance can be used. As part of designing an image guidance system, all arms of the robot need to be co-localized in a common coordinate system. In order to track multiple arms in a common coordinate space, intrinsic and extrinsic tracking methods can be used. First, the intrinsic tracking of the daVinci, specifically of the setup joints is analyzed. Because of the inadequacy of the setup joints for co-localization a hybrid tracking method is designed and implemented to mitigate the inaccuracy of the setup joints. Different both optical and magnetic tracking methods are examined for setup joint localization. The hybrid localization method improved the localization accuracy of the setup joints. The inter-arm accuracy in hybrid localization was improved to 3.02 mm. This inter-arm error value was shown to be further reduced when the arms are co-registered, thus reducing common error. (orig.)

  18. An effective visualisation and registration system for image-guided robotic partial nephrectomy.

    Science.gov (United States)

    Pratt, Philip; Mayer, Erik; Vale, Justin; Cohen, Daniel; Edwards, Eddie; Darzi, Ara; Yang, Guang-Zhong

    2012-03-01

    Robotic partial nephrectomy is presently the fastest-growing robotic surgical procedure, and in comparison to traditional techniques it offers reduced tissue trauma and likelihood of post-operative infection, while hastening recovery time and improving cosmesis. It is also an ideal candidate for image guidance technology since soft tissue deformation, while still present, is localised and less problematic compared to other surgical procedures. This work describes the implementation and ongoing development of an effective image guidance system that aims to address some of the remaining challenges in this area. Specific innovations include the introduction of an intuitive, partially automated registration interface, and the use of a hardware platform that makes sophisticated augmented reality overlays practical in real time. Results and examples of image augmentation are presented from both retrospective and live cases. Quantitative analysis of registration error verifies that the proposed registration technique is appropriate for the chosen image guidance targets.

  19. Toward real-time tumor margin identification in image-guided robotic brain tumor resection

    Science.gov (United States)

    Hu, Danying; Jiang, Yang; Belykh, Evgenii; Gong, Yuanzheng; Preul, Mark C.; Hannaford, Blake; Seibel, Eric J.

    2017-03-01

    For patients with malignant brain tumors (glioblastomas), a safe maximal resection of tumor is critical for an increased survival rate. However, complete resection of the cancer is hard to achieve due to the invasive nature of these tumors, where the margins of the tumors become blurred from frank tumor to more normal brain tissue, but in which single cells or clusters of malignant cells may have invaded. Recent developments in fluorescence imaging techniques have shown great potential for improved surgical outcomes by providing surgeons intraoperative contrast-enhanced visual information of tumor in neurosurgery. The current near-infrared (NIR) fluorophores, such as indocyanine green (ICG), cyanine5.5 (Cy5.5), 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX), are showing clinical potential to be useful in targeting and guiding resections of such tumors. Real-time tumor margin identification in NIR imaging could be helpful to both surgeons and patients by reducing the operation time and space required by other imaging modalities such as intraoperative MRI, and has the potential to integrate with robotically assisted surgery. In this paper, a segmentation method based on the Chan-Vese model was developed for identifying the tumor boundaries in an ex-vivo mouse brain from relatively noisy fluorescence images acquired by a multimodal scanning fiber endoscope (mmSFE). Tumor contours were achieved iteratively by minimizing an energy function formed by a level set function and the segmentation model. Quantitative segmentation metrics based on tumor-to-background (T/B) ratio were evaluated. Results demonstrated feasibility in detecting the brain tumor margins at quasi-real-time and has the potential to yield improved precision brain tumor resection techniques or even robotic interventions in the future.

  20. SU-E-T-453: A Novel Daily QA System for Robotic Image Guided Radiosurgery with Variable Aperture Collimator

    Energy Technology Data Exchange (ETDEWEB)

    Wang, L [Stanford University Medical School, Palo Alto, CA (United States); Nelson, B [Logos Systems Int' l., Scotts Valley, CA (United States)

    2014-06-01

    Purpose: A novel end-to-end system using a CCD camera and a scintillator based phantom that is capable of measuring the beam-by-beam delivery accuracy of Robotic Radiosurgery has been developed and reported in our previous work. This work investigates its application to end-to-end type daily QA for Robotic Radiosurgery (Cyberknife) with Variable Aperture Collimator (Iris). Methods: The phantom was first scanned with a CT scanner at 0.625 slice thickness and exported to the Cyberknife Muliplan (v4.6) treatment planning system. An isocentric treatment plan was created consisting of ten beams of 25 Monitor Units each using Iris apertures of 7.5, 10, 15, 20, and 25 mm. The plan was delivered six times in two days on the Cyberknife G4 system with fiducial tracking on the four metal fiducials embedded in phantom with re-positioning between the measurements. The beam vectors (X, Y, Z) are measured and compared with the plan from the machine delivery file (XML file). The Iris apertures (FWHM) were measured from the beam flux map and compared with the commissioning data. Results: The average beam positioning accuracies of the six deliveries are 0.71 ± 0.40 mm, 0.72 ± 0.44 mm, 0.74 ± 0.42 mm, 0.70 ± 0.40 mm, 0.79 ± 0.44 mm and 0.69 ± 0.41 mm respectively. Radiation beam width (FWHM) variations are within ±0.05 mm, and they agree with the commissioning data within 0.22 mm. The delivery time for the plan is about 7 minutes and the results are given instantly. Conclusion: The experimental results agree with stated sub-millimeter delivery accuracy of Cyberknife system. Beam FWHM variations comply with the 0.2 mm accuracy of the Iris collimator at SAD. The XRV-100 system has proven to be a powerful tool in performing end-to-end type tests for Robotic Image Guided Radiosurgery Daily QA.

  1. Dosimetric and deformation effects of image-guided interventions during stereotactic body radiation therapy of the prostate using an endorectal balloon

    Energy Technology Data Exchange (ETDEWEB)

    Jones, Bernard L.; Gan, Gregory; Diot, Quentin; Kavanagh, Brian; Timmerman, Robert D.; Miften, Moyed [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045 (United States); Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas 75390 (United States); Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045 (United States)

    2012-06-15

    .9% (p = 0.03). Additionally, ERB interventions reduced prostate deformation in the anterior-posterior (AP) direction, reduced errors in the sagittal rotation of the prostate, and increased the similarity in shape of the prostate to the radiotherapy plan (increased Dice coefficient from 0.76 {+-} 0.06 to 0.80 {+-} 0.04, p = 0.01). Postintervention decreases in prostate volume receiving less than the prescribed dose and decreases in the voxel-wise displacement of the prostate, bladder, and anterior rectal wall were observed, which resulted in improved dose-volume histogram (DVH) characteristics. Conclusions: Image-guided interventions in ERB volume and/or position during prostate SBRT were necessary to ensure the delivery of the dose distribution as planned. ERB interventions resulted in reductions in prostate deformations that would have prevented accurate localization of patient anatomy.

  2. Tumor Control Outcomes After Hypofractionated and Single-Dose Stereotactic Image-Guided Intensity-Modulated Radiotherapy for Extracranial Metastases From Renal Cell Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Greco, Carlo [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Motzer, Robert [Solid Tumor Service, Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Magsanoc, Juan Martin; Pei Xin [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lovelock, Michael; Mechalakos, Jim [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zatcky, Joan; Fuks, Zvi; Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-04-01

    Purpose: To report tumor local progression-free outcomes after treatment with single-dose, image-guided, intensity-modulated radiotherapy and hypofractionated regimens for extracranial metastases from renal cell primary tumors. Patients and Methods: Between 2004 and 2010, 105 lesions from renal cell carcinoma were treated with either single-dose, image-guided, intensity-modulated radiotherapy to a prescription dose of 18-24 Gy (median, 24) or hypofractionation (three or five fractions) with a prescription dose of 20-30 Gy. The median follow-up was 12 months (range, 1-48). Results: The overall 3-year actuarial local progression-free survival for all lesions was 44%. The 3-year local progression-free survival for those who received a high single-dose (24 Gy; n = 45), a low single-dose (<24 Gy; n = 14), or hypofractionation regimens (n = 46) was 88%, 21%, and 17%, respectively (high single dose vs. low single dose, p = .001; high single dose vs. hypofractionation, p < .001). Multivariate analysis revealed the following variables were significant predictors of improved local progression-free survival: 24 Gy dose compared with a lower dose (p = .009) and a single dose vs. hypofractionation (p = .008). Conclusion: High single-dose, image-guided, intensity-modulated radiotherapy is a noninvasive procedure resulting in high probability of local tumor control for metastatic renal cell cancer generally considered radioresistant according to the classic radiobiologic ranking.

  3. [Cyberknife robotic stereotactic radiotherapy: technical aspects and recent developments].

    Science.gov (United States)

    Thariat, J; Marcié, S; Marcy, P-Y; Trimaud, R; Angellier, G; Mammar, H; Bondiau, P-Y; Gerard, J-P

    2010-07-01

    Cyberknife (Accuray Inc. Sunnyvale, USA) stereotactic body radiation therapy (SBRT) involves the delivery of a small number of large doses of radiation to a target volume using continuously evolving advanced technology. It has emerged as a novel treatment modality for cancer and modified some concepts of cancer treatment. It is indicated in early-stage primary cancer, sometimes as an alternative to surgery. It is also indicated for patients with oligometastatic disease who have relatively long survival with the aim to optimize disease control with a good quality of life. Although there remain some uncertainties regarding the radiobiology of hypofractionation, local control and tolerance have been promising. Indications are increasing under strict quality assurance programs worldwide and prospective clinical evaluation.

  4. The geometric accuracy of frameless stereotactic radiosurgery using a 6D robotic couch system

    Energy Technology Data Exchange (ETDEWEB)

    Takakura, T; Nakata, M; Yano, S; Fujimoto, T [Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto (Japan); Mizowaki, T; Miyabe, Y; Nakamura, M; Hiraoka, M [Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan)], E-mail: toru1@kuhp.kyoto-u.ac.jp

    2010-01-07

    The aim of this paper is to assess the overall geometric accuracy of the Novalis system using the Robotic Tilt Module in terms of the uncertainty in frameless stereotactic radiotherapy. We analyzed the following three metrics: (1) the correction accuracy of the robotic couch, (2) the uncertainty of the isocenter position with gantry and couch rotation, and (3) the shift in position between the isocenter and central point detected with the ExacTrac x-ray system. Based on the concept of uncertainty, the overall accuracy was calculated from these values. The accuracy in positional correction with the robotic couch was 0.07 {+-} 0.22 mm, the positional shift of the isocenter associated with gantry rotation was 0.35 mm, the positional shift of the isocenter associated with couch rotation was 0.38 mm and the difference in position between the isocenter and the ExacTrac x-ray system was 0.30 mm. The accuracy of intracranial stereotactic radiosurgery with the Novalis system in our clinic was 0.31 {+-} 0.77 mm. The overall geometric accuracy based on the concept of uncertainty was 0.31 {+-} 0.77 mm, which is within the tolerance given in the American Association of Physicists in Medicine report no. 54.

  5. The geometric accuracy of frameless stereotactic radiosurgery using a 6D robotic couch system.

    Science.gov (United States)

    Takakura, T; Mizowaki, T; Nakata, M; Yano, S; Fujimoto, T; Miyabe, Y; Nakamura, M; Hiraoka, M

    2010-01-07

    The aim of this paper is to assess the overall geometric accuracy of the Novalis system using the Robotic Tilt Module in terms of the uncertainty in frameless stereotactic radiotherapy. We analyzed the following three metrics: (1) the correction accuracy of the robotic couch, (2) the uncertainty of the isocenter position with gantry and couch rotation, and (3) the shift in position between the isocenter and central point detected with the ExacTrac x-ray system. Based on the concept of uncertainty, the overall accuracy was calculated from these values. The accuracy in positional correction with the robotic couch was 0.07 +/- 0.22 mm, the positional shift of the isocenter associated with gantry rotation was 0.35 mm, the positional shift of the isocenter associated with couch rotation was 0.38 mm and the difference in position between the isocenter and the ExacTrac x-ray system was 0.30 mm. The accuracy of intracranial stereotactic radiosurgery with the Novalis system in our clinic was 0.31 +/- 0.77 mm. The overall geometric accuracy based on the concept of uncertainty was 0.31 +/- 0.77 mm, which is within the tolerance given in the American Association of Physicists in Medicine report no. 54.

  6. SU-E-J-12: An Image-Guided Soft Robotic Patient Positioning System for Maskless Head-And-Neck Cancer Radiotherapy: A Proof-Of-Concept Study

    Energy Technology Data Exchange (ETDEWEB)

    Ogunmolu, O; Gans, N [The University of Texas at Dallas, Richardson, TX (United States); Jiang, S; Gu, X [UT Southwestern Medical Center, Dallas, TX (United States)

    2015-06-15

    Purpose: We propose a surface-image-guided soft robotic patient positioning system for maskless head-and-neck radiotherapy. The ultimate goal of this project is to utilize a soft robot to realize non-rigid patient positioning and real-time motion compensation. In this proof-of-concept study, we design a position-based visual servoing control system for an air-bladder-based soft robot and investigate its performance in controlling the flexion/extension cranial motion on a mannequin head phantom. Methods: The current system consists of Microsoft Kinect depth camera, an inflatable air bladder (IAB), pressured air source, pneumatic valve actuators, custom-built current regulators, and a National Instruments myRIO microcontroller. The performance of the designed system was evaluated on a mannequin head, with a ball joint fixed below its neck to simulate torso-induced head motion along flexion/extension direction. The IAB is placed beneath the mannequin head. The Kinect camera captures images of the mannequin head, extracts the face, and measures the position of the head relative to the camera. This distance is sent to the myRIO, which runs control algorithms and sends actuation commands to the valves, inflating and deflating the IAB to induce head motion. Results: For a step input, i.e. regulation of the head to a constant displacement, the maximum error was a 6% overshoot, which the system then reduces to 0% steady-state error. In this initial investigation, the settling time to reach the regulated position was approximately 8 seconds, with 2 seconds of delay between the command start of motion due to capacitance of the pneumatics, for a total of 10 seconds to regulate the error. Conclusion: The surface image-guided soft robotic patient positioning system can achieve accurate mannequin head flexion/extension motion. Given this promising initial Result, the extension of the current one-dimensional soft robot control to multiple IABs for non-rigid positioning control

  7. Dosimetric and Deformation Effects of Image-Guided Interventions during Stereotactic Body Radiation Therapy of the Prostate using an Endorectal Balloon

    CERN Document Server

    Jones, Bernard L; Diot, Quentin; Kavanagh, Brian; Timmerman, Robert D; Miften, Moyed

    2013-01-01

    During Stereotactic Body Radiotherapy (SBRT) for the treatment of prostate cancer, an inflatable endorectal balloon (ERB) may be used to reduce motion of the target and reduce the dose to the posterior rectal wall. This work assessed the dosimetric impact of manual interventions on ERB position in patients receiving prostate SBRT and investigated the impact of ERB interventions on prostate shape. Daily kilovoltage (kV) cone-beam computed tomography (CBCT) imaging was performed to localize the PTV, and an automated fusion with the planning images yielded displacements required for PTV re-localization. When the ERB volume and/or position were judged to yield inaccurate repositioning, manual adjustment (ERB re-inflation and/or repositioning) was performed. Based on all 59 CBCT image sets acquired, a deformable registration algorithm was used to determine the dose received by, displacement of, and deformation of the prostate, bladder, and anterior rectal wall. This dose tracking methodology was applied to images ...

  8. An Ultra-High Field Strength MR Image-Guided Robotic Needle Delivery System for In-Bore Small Animal Interventions.

    Science.gov (United States)

    Gravett, Matthew; Cepek, Jeremy; Fenster, Aaron

    2017-08-28

    To develop and validate an image-guided robotic needle delivery system for accurate and repeatable needle targeting procedures in mouse brains inside the 12cm inner diameter gradient coil insert of a 9.4T MR scanner. Many preclinical research techniques require the use of accurate needle deliveries to soft tissues, including brain tissue. Soft tissues are optimally visualized in MR images, which offer high-soft tissue contrast, as well as a range of unique imaging techniques, including functional, spectroscopy and thermal imaging, however, there are currently no solutions for delivering needles to small animal brains inside the bore of an ultra-high field MR scanner. This paper describes the mechatronic design, evaluation of MR compatibility, registration technique, mechanical calibration, the quantitative validation of the in-bore image-guided needle targeting accuracy and repeatability, and demonstrated the system's ability to deliver needles in-situ. Our six degree-of-freedom, MR compatible, mechatronic system was designed to fit inside the bore of a 9.4T MR scanner and is actuated using a combination of piezoelectric and hydraulic mechanisms. The MR compatibility and targeting accuracy of the needle delivery system are evaluated to ensure that the system is precisely calibrated to perform the needle targeting procedures. A semi-automated image registration is performed to link the robot coordinates to the MR coordinate system. Soft tissue targets can be accurately localized in MR images, followed by automatic alignment of the needle trajectory to the target. Intra-procedure visualization of the needle target location and the needle were confirmed through MR images after needle insertion. The effects of geometric distortions and signal noise were found to be below threshold that would have an impact on the accuracy of the system. The system was found to have negligible effect on the MR image signal noise and geometric distortion. The system was mechanically

  9. Minimal Inter-Fractional Fiducial Migration during Image-Guided Lung Stereotactic Body Radiotherapy Using SuperLock Nitinol Coil Fiducial Markers.

    Directory of Open Access Journals (Sweden)

    Yi Rong

    Full Text Available Stereotactic body radiotherapy (SBRT is being increasingly used for the treatment of patients with lung cancer or lung metastasis who are medically unfit to undergo resection. In order to improve accuracy and confidence in targeting tumors, many centers rely on fiducial implantation. We evaluated the migration of a novel fiducial marker specifically designed for lung tissue implanted via electromagnetic navigation bronchoscopy (ENB.We retrospectively quantified the individual and group migrations of SuperLock nitinol coil fiducials for 15 patients receiving lung stereotactic body radiotherapy (SBRT, in order to evaluate the reliability of using these fiducials as a target surrogate for cases where tumors cannot be clearly delineated on cone beam CTs (CBCTs. For each fraction, we compared the individual and group migrations of the fiducials between the planning CT and the acquired CBCT. The group migration was defined as the distance between the centroids of the fiducial group and GTV.A total of 16 lung targets were included in our study for these 15 patients (one patient with two targets. Of 55 fiducials placed, we observed a 100% retention rate. The mean individual migration was 1.87 mm (range, 0.63-5.25 mm with a standard deviation of 1.26 mm. The mean group migration was 1.94 mm (range, 0.03-6.19 mm with a standard deviation of 1.45 mm. Overall, there was minimal change in the relative locations of the markers with respect to each other, as well as to the target.We found that the SuperLock nitinol coil fiducial marker positions are stable throughout the radiation treatment, and can be used as a reliable surrogate to target, and to avoid geometric misses during gated treatments.

  10. Experiential Learning of Robotics Fundamentals Based on a Case Study of Robot-Assisted Stereotactic Neurosurgery

    Science.gov (United States)

    Faria, Carlos; Vale, Carolina; Machado, Toni; Erlhagen, Wolfram; Rito, Manuel; Monteiro, Sérgio; Bicho, Estela

    2016-01-01

    Robotics has been playing an important role in modern surgery, especially in procedures that require extreme precision, such as neurosurgery. This paper addresses the challenge of teaching robotics to undergraduate engineering students, through an experiential learning project of robotics fundamentals based on a case study of robot-assisted…

  11. Magnetic resonance-compatible robotic and mechatronics systems for image-guided interventions and rehabilitation: a review study.

    Science.gov (United States)

    Tsekos, Nikolaos V; Khanicheh, Azadeh; Christoforou, Eftychios; Mavroidis, Constantinos

    2007-01-01

    The continuous technological progress of magnetic resonance imaging (MRI), as well as its widespread clinical use as a highly sensitive tool in diagnostics and advanced brain research, has brought a high demand for the development of magnetic resonance (MR)-compatible robotic/mechatronic systems. Revolutionary robots guided by real-time three-dimensional (3-D)-MRI allow reliable and precise minimally invasive interventions with relatively short recovery times. Dedicated robotic interfaces used in conjunction with fMRI allow neuroscientists to investigate the brain mechanisms of manipulation and motor learning, as well as to improve rehabilitation therapies. This paper gives an overview of the motivation, advantages, technical challenges, and existing prototypes for MR-compatible robotic/mechatronic devices.

  12. Imaged-guided liver stereotactic body radiotherapy using VMAT and real-time adaptive tumor gating. Concerns about technique and preliminary clinical results.

    Science.gov (United States)

    Llacer-Moscardo, Carmen; Riou, Olivier; Azria, David; Bedos, Ludovic; Ailleres, Norbert; Quenet, Francois; Rouanet, Philippe; Ychou, Marc; Fenoglietto, Pascal

    2017-01-01

    Motion management is a major challenge in abdominal SBRT. We present our study of SBRT for liver tumors using intrafraction motion review (IMR) allowing simultaneous KV information and MV delivery to synchronize the beam during gated RapidArc treatment. Between May 2012 and March 2015, 41 patients were treated by liver SBRT using gated RapidArc technique in a Varian Novalis Truebeam STx linear accelerator. PTV was created by expanding 5 mm from the ITV. Dose prescription ranged from 40 to 50 Gy in 5-10 fractions. The prescribed dose and fractionation were chosen depending on hepatic function and dosimetric results. Thirty-four patients with a minimal follow-up of six months were analyzed for local control and toxicity. Accuracy for tumor repositioning was evaluated for the first ten patients. With a median follow-up of 13 months, the treatment was well tolerated and no patient presented RILD, perforation or gastrointestinal bleeding. Acute toxicity was found in 3 patients with G1 abdominal pain, 2 with G1 nausea, 10 with G1 asthenia and 1 with G2 asthenia. 6 patients presented asymptomatic transitory perturbation of liver enzymes. In-field local control was 90.3% with 7 complete responses, 14 partial responses and 7 stabilisations. 3 patients evolved "in field". 12 patients had an intrahepatic progression "out of field". Mean intrafraction deviation of fiducials in the craneo-caudal direction was 0.91 mm (0-6 mm). The clinical tolerance and oncological outcomes were favorable when using image-guided liver SBRT with real-time adaptive tumor gating.

  13. Experimental new automatic tools for robotic stereotactic neurosurgery: towards "no hands" procedure of leads implantation into a brain target.

    Science.gov (United States)

    Mazzone, P; Arena, P; Cantelli, L; Spampinato, G; Sposato, S; Cozzolino, S; Demarinis, P; Muscato, G

    2016-07-01

    The use of robotics in neurosurgery and, particularly, in stereotactic neurosurgery, is becoming more and more adopted because of the great advantages that it offers. Robotic manipulators easily allow to achieve great precision, reliability, and rapidity in the positioning of surgical instruments or devices in the brain. The aim of this work was to experimentally verify a fully automatic "no hands" surgical procedure. The integration of neuroimaging to data for planning the surgery, followed by application of new specific surgical tools, permitted the realization of a fully automated robotic implantation of leads in brain targets. An anthropomorphic commercial manipulator was utilized. In a preliminary phase, a software to plan surgery was developed, and the surgical tools were tested first during a simulation and then on a skull mock-up. In such a way, several tools were developed and tested, and the basis for an innovative surgical procedure arose. The final experimentation was carried out on anesthetized "large white" pigs. The determination of stereotactic parameters for the correct planning to reach the intended target was performed with the same technique currently employed in human stereotactic neurosurgery, and the robotic system revealed to be reliable and precise in reaching the target. The results of this work strengthen the possibility that a neurosurgeon may be substituted by a machine, and may represent the beginning of a new approach in the current clinical practice. Moreover, this possibility may have a great impact not only on stereotactic functional procedures but also on the entire domain of neurosurgery.

  14. AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: report of Task Group 192.

    Science.gov (United States)

    Podder, Tarun K; Beaulieu, Luc; Caldwell, Barrett; Cormack, Robert A; Crass, Jostin B; Dicker, Adam P; Fenster, Aaron; Fichtinger, Gabor; Meltsner, Michael A; Moerland, Marinus A; Nath, Ravinder; Rivard, Mark J; Salcudean, Tim; Song, Danny Y; Thomadsen, Bruce R; Yu, Yan

    2014-10-01

    In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicists in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy & Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3-6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests should

  15. Feasibility report of image guided stereotactic body radiotherapy (IG-SBRT) with tomotherapy for early stage medically inoperable lung cancer using extreme hypofractionation

    Energy Technology Data Exchange (ETDEWEB)

    Hodge, Wes; Tome, Wolfgang A.; Jaradat, Hazim A.; Orton, Nigel P.; Khuntia, Deepak; Mehta, Minesh P. [Univ. of Wisconsin School of Medicine and Public Health, Madison, WI (United States). Dept. of Human Oncology; Traynor, Anne [Univ. of Wisconsin School of Medicine and Public Health, Madison, WI (United States). Dept. of Medicine; Weigel, Tracey [Univ. of Wisconsin School of Medicine and Public Health, Madison, WI (United States). Dept. of Surgery

    2006-09-15

    We report on the technical feasibility, dosimetric aspects, and daily image-guidance capability with megavoltage CT (MVCT) of stereotactic body radiotherapy (SBRT) using helical tomotherapy for medically inoperable T1/2 N0 M0 non-small cell lung cancer. Nine patients underwent treatment planning with 4D-CT in a double vacuum based immobilization system to minimize tumor motion and to define a lesion-specific 4D-motion envelope. Patients received 60 Gy in 5 fractions within 10 days to a PTV defined by a motion envelope plus a 6 mm expansion for microscopic extension and setup error using tomotherapy, with daily pretreatment MVCT image guidance. The primary endpoint was technical feasibility. Secondary endpoints were defining the acute and sub-acute toxicities and tumor response. Forty three of 45 fractions were successfully delivered, with an average delivery time of 22 minutes. MVCT provided excellent tumor visualization for daily image guidance. No significant tumor regression was observed on MVCT in any patient during therapy. Median mean normalized total doses were: tumor 117 Gy{sub 10}; residual lung 9 Gy{sub 3}. Maximum fraction-size equivalent dose values were: esophagus 5 Gy{sub 3}{sup 9}; cord 7 Gy{sub 3}{sup 6}. No patient experienced = grade 2 pulmonary toxicity. 3 complete, 4 partial and 2 stable responses were observed, with <3 months median follow-up. The mean tumor regression is 72%. SBRT using tomotherapy proved to be feasible, safe and free of major technical limitations or acute toxicities. Daily pretreatment MVCT imaging allows for precise daily tumor targeting with the patient in the actual treatment position, and therefore provides for precise image guidance.

  16. Use of Image-Guided Stereotactic Body Radiation Therapy in Lieu of Intracavitary Brachytherapy for the Treatment of Inoperable Endometrial Neoplasia

    Energy Technology Data Exchange (ETDEWEB)

    Kemmerer, Eric [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Hernandez, Enrique; Ferriss, James S. [Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Valakh, Vladimir; Miyamoto, Curtis; Li, Shidong [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Micaily, Bizhan, E-mail: bizhan.micaily@tuhs.temple.edu [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States)

    2013-01-01

    Purpose: Retrospective analysis of patients with invasive endometrial neoplasia who were treated with external beam radiation therapy followed by stereotactic body radiation therapy (SBRT) boost because of the inability to undergo surgery or brachytherapy. Methods and Materials: We identified 11 women with stage I-III endometrial cancer with a median age of 78 years that were not candidates for hysterectomy or intracavitary brachytherapy secondary to comorbidities (91%) or refusal (9%). Eight patients were American Joint Committee on Cancer (AJCC) stage I (3 stage IA, 5 stage IB), and 3 patients were AJCC stage III. Patients were treated to a median of 4500 cGy at 180 cGy per fraction followed by SBRT boost (600 cGy per fraction Multiplication-Sign 5). Results: The most common side effect was acute grade 1 gastrointestinal toxicity in 73% of patients, with no late toxicities observed. With a median follow-up of 10 months since SBRT, 5 patients (45%) experienced locoregional disease progression, with 3 patients (27%) succumbing to their malignancy. At 12 and 18 months from SBRT, the overall freedom from progression was 68% and 41%, respectively. Overall freedom from progression (FFP) was 100% for all patients with AJCC stage IA endometrial carcinoma, whereas it was 33% for stage IB at 18 months. The overall FFP was 100% for International Federation of Obstetrics and Gynecology grade 1 disease. The estimated overall survival was 57% at 18 months from diagnosis. Conclusion: In this study, SBRT boost to the intact uterus was feasible, with encouragingly low rates of acute and late toxicity, and favorable disease control in patients with early-stage disease. Additional studies are needed to provide better insight into the best management of these clinically challenging cases.

  17. AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: Report of Task Group 192

    Energy Technology Data Exchange (ETDEWEB)

    Podder, Tarun K., E-mail: tarun.podder@uhhospitals.org [Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, Ohio 44122 (United States); Beaulieu, Luc [Department of Radiation Oncology, Centre Hospitalier Univ de Quebec, Quebec G1R 2J6 (Canada); Caldwell, Barrett [Schools of Industrial Engineering and Aeronautics and Astronautics, Purdue University, West Lafayette, Indiana 47907 (United States); Cormack, Robert A. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts 02115 (United States); Crass, Jostin B. [Department of Radiation Oncology, Vanderbilt University, Nashville, Tennessee 37232 (United States); Dicker, Adam P.; Yu, Yan [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107 (United States); Fenster, Aaron [Department of Imaging Research, Robarts Research Institute, London, Ontario N6A 5K8 (Canada); Fichtinger, Gabor [School of Computer Science, Queen’s University, Kingston, Ontario K7L 3N6 (Canada); Meltsner, Michael A. [Philips Radiation Oncology Systems, Fitchburg, Wisconsin 53711 (United States); Moerland, Marinus A. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht, 3508 GA (Netherlands); Nath, Ravinder [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520 (United States); Rivard, Mark J. [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts 02111 (United States); Salcudean, Tim [Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia V6T 1Z4 (Canada); Song, Danny Y. [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231 (United States); Thomadsen, Bruce R. [Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 (United States)

    2014-10-15

    In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicists in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3–6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests

  18. The comparative accuracy of the ROSA stereotactic robot across a wide range of clinical applications and registration techniques.

    Science.gov (United States)

    Brandmeir, Nicholas J; Savaliya, Sandip; Rohatgi, Pratik; Sather, Michael

    2017-05-08

    Robot-assisted stereotactic neurosurgery is an emerging technology with a growing range of applications. The ROSA system is a robotic stereotactic system that has been shown to be accurate in laboratory studies and large case series. The goal of this study was to examine the accuracy of the ROSA across different registration methods as well as different clinical applications. Sixteen patients with one hundred and seventeen stereotactic trajectories were examined. Accuracy was compared by measuring the distance between the trajectory target and the actual termination of the device as determined by imaging. Entry error and angular deviation were also measured. Variables included bone fiducials vs. laser facial scanning, the clinical indication for stereotactic surgery, and the effect of lead deflection on accuracy. Bone fiducials did not offer an accuracy benefit over laser facial scanning (mean target error 4.5-3.9 mm, p = 0.34) in these clinical scenarios. Laser interstitial thermal therapy, responsive neurostimulation, and stereo electroencephalography were equally accurate when placed by the ROSA (mean target error 4.4-4.3-4.0 mm, respectively, p = 0.69). Deflection did not affect lead accuracy (mean target error 4.4-3.9 mm, p = 0.11). Similar results are seen for entry error and angular deviation. ROSA is a highly accurate stereotactic system. Laser facial scanning provides the same accuracy as bone fiducials in these stereotactic applications. The ROSA is equally accurate across a wide spectrum of applications. The ROSA is effective at limiting lead deflection, and when it does occur, it does not impact target accuracy in a significant way.

  19. A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Avkshtol V

    2016-08-01

    Full Text Available Vladimir Avkshtol, Yanqun Dong, Shelly B Hayes, Mark A Hallman, Robert A Price, Mark L Sobczak, Eric M Horwitz,* Nicholas G Zaorsky* Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA *These authors contributed equally to this work Abstract: Prostate cancer is the most prevalent cancer diagnosed in men in the United States besides skin cancer. Stereotactic body radiation therapy (SBRT; 6–15 Gy per fraction, up to 45 minutes per fraction, delivered in five fractions or less, over the course of approximately 2 weeks is emerging as a popular treatment option for prostate cancer. The American Society for Radiation Oncology now recognizes SBRT for select low- and intermediate-risk prostate cancer patients. SBRT grew from the notion that high doses of radiation typical of brachytherapy could be delivered noninvasively using modern external-beam radiation therapy planning and delivery methods. SBRT is most commonly delivered using either a traditional gantry-mounted linear accelerator or a robotic arm-mounted linear accelerator. In this systematic review article, we compare and contrast the current clinical evidence supporting a gantry vs robotic arm SBRT for prostate cancer. The data for SBRT show encouraging and comparable results in terms of freedom from biochemical failure (>90% for low and intermediate risk at 5–7 years and acute and late toxicity (<6% grade 3–4 late toxicities. Other outcomes (eg, overall and cancer-specific mortality cannot be compared, given the indolent course of low-risk prostate cancer. At this time, neither SBRT device is recommended over the other for all patients; however, gantry-based SBRT machines have the abilities of treating larger volumes with conventional fractionation, shorter treatment time per fraction (~15 minutes for gantry vs ~45 minutes for robotic arm, and the ability to achieve better plans among obese patients (since they are able to use energies >6 MV. Finally

  20. Robotic real-time translational and rotational head motion correction during frameless stereotactic radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Xinmin; Belcher, Andrew H.; Grelewicz, Zachary; Wiersma, Rodney D., E-mail: rwiersma@uchicago.edu [Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637 (United States)

    2015-06-15

    Purpose: To develop a control system to correct both translational and rotational head motion deviations in real-time during frameless stereotactic radiosurgery (SRS). Methods: A novel feedback control with a feed-forward algorithm was utilized to correct for the coupling of translation and rotation present in serial kinematic robotic systems. Input parameters for the algorithm include the real-time 6DOF target position, the frame pitch pivot point to target distance constant, and the translational and angular Linac beam off (gating) tolerance constants for patient safety. Testing of the algorithm was done using a 4D (XY Z + pitch) robotic stage, an infrared head position sensing unit and a control computer. The measured head position signal was processed and a resulting command was sent to the interface of a four-axis motor controller, through which four stepper motors were driven to perform motion compensation. Results: The control of the translation of a brain target was decoupled with the control of the rotation. For a phantom study, the corrected position was within a translational displacement of 0.35 mm and a pitch displacement of 0.15° 100% of the time. For a volunteer study, the corrected position was within displacements of 0.4 mm and 0.2° over 98.5% of the time, while it was 10.7% without correction. Conclusions: The authors report a control design approach for both translational and rotational head motion correction. The experiments demonstrated that control performance of the 4D robotic stage meets the submillimeter and subdegree accuracy required by SRS.

  1. A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer.

    Science.gov (United States)

    Avkshtol, Vladimir; Dong, Yanqun; Hayes, Shelly B; Hallman, Mark A; Price, Robert A; Sobczak, Mark L; Horwitz, Eric M; Zaorsky, Nicholas G

    2016-01-01

    Prostate cancer is the most prevalent cancer diagnosed in men in the United States besides skin cancer. Stereotactic body radiation therapy (SBRT; 6-15 Gy per fraction, up to 45 minutes per fraction, delivered in five fractions or less, over the course of approximately 2 weeks) is emerging as a popular treatment option for prostate cancer. The American Society for Radiation Oncology now recognizes SBRT for select low- and intermediate-risk prostate cancer patients. SBRT grew from the notion that high doses of radiation typical of brachytherapy could be delivered noninvasively using modern external-beam radiation therapy planning and delivery methods. SBRT is most commonly delivered using either a traditional gantry-mounted linear accelerator or a robotic arm-mounted linear accelerator. In this systematic review article, we compare and contrast the current clinical evidence supporting a gantry vs robotic arm SBRT for prostate cancer. The data for SBRT show encouraging and comparable results in terms of freedom from biochemical failure (>90% for low and intermediate risk at 5-7 years) and acute and late toxicity (cancer-specific mortality) cannot be compared, given the indolent course of low-risk prostate cancer. At this time, neither SBRT device is recommended over the other for all patients; however, gantry-based SBRT machines have the abilities of treating larger volumes with conventional fractionation, shorter treatment time per fraction (~15 minutes for gantry vs ~45 minutes for robotic arm), and the ability to achieve better plans among obese patients (since they are able to use energies >6 MV). Finally, SBRT (particularly on a gantry) may also be more cost-effective than conventionally fractionated external-beam radiation therapy. Randomized controlled trials of SBRT using both technologies are underway.

  2. Proposal for a Simple and Efficient Monthly Quality Management Program Assessing the Consistency of Robotic Image-Guided Small Animal Radiation Systems.

    Science.gov (United States)

    Brodin, N Patrik; Guha, Chandan; Tomé, Wolfgang A

    2015-11-01

    Modern pre-clinical radiation therapy (RT) research requires high precision and accurate dosimetry to facilitate the translation of research findings into clinical practice. Several systems are available that provide precise delivery and on-board imaging capabilities, highlighting the need for a quality management program (QMP) to ensure consistent and accurate radiation dose delivery. An ongoing, simple, and efficient QMP for image-guided robotic small animal irradiators used in pre-clinical RT research is described. Protocols were developed and implemented to assess the dose output constancy (based on the AAPM TG-61 protocol), cone-beam computed tomography (CBCT) image quality and object representation accuracy (using a custom-designed imaging phantom), CBCT-guided target localization accuracy and consistency of the CBCT-based dose calculation. To facilitate an efficient read-out and limit the user dependence of the QMP data analysis, a semi-automatic image analysis and data representation program was developed using the technical computing software MATLAB. The results of the first 6-mo experience using the suggested QMP for a Small Animal Radiation Research Platform (SARRP) are presented, with data collected on a bi-monthly basis. The dosimetric output constancy was established to be within ±1 %, the consistency of the image resolution was within ±0.2 mm, the accuracy of CBCT-guided target localization was within ±0.5 mm, and dose calculation consistency was within ±2 s (±3%) per treatment beam. Based on these results, this simple quality assurance program allows for the detection of inconsistencies in dosimetric or imaging parameters that are beyond the acceptable variability for a reliable and accurate pre-clinical RT system, on a monthly or bi-monthly basis.

  3. Hematological Toxicity After Robotic Stereotactic Body Radiosurgery for Treatment of Metastatic Gynecologic Malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Kunos, Charles A., E-mail: charles.kunos@UHhospitals.org [Department of Radiation Oncology, University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Debernardo, Robert [Department of Obstetrics and Gynecology, University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Radivoyevitch, Tomas [Department of Epidemiology and Biostatistics, University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Fabien, Jeffrey; Dobbins, Donald C.; Zhang Yuxia; Brindle, James [Department of Radiation Oncology, University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States)

    2012-09-01

    Purpose: To evaluate hematological toxicity after robotic stereotactic body radiosurgery (SBRT) for treatment of women with metastatic abdominopelvic gynecologic malignancies. Methods and Materials: A total of 61 women with stage IV gynecologic malignancies treated with abdominopelvic SBRT were analyzed after ablative radiation (2400 cGy/3 divided consecutive daily doses) delivered by a robotic-armed Cyberknife SBRT system. Abdominopelvic bone marrow was identified using computed tomography-guided contouring. Fatigue and hematologic toxicities were graded by retrospective assignment of common toxicity criteria for adverse events (version 4.0). Bone marrow volume receiving 1000 cGy (V10) was tested for association with post-therapy (median 32 days [25%-75% quartile, 28-45 days]) white- or red-cell counts, hemoglobin levels, and platelet counts as marrow toxicity surrogates. Results: In all, 61 women undergoing abdominopelvic SBRT had a median bone marrow V10 of 2% (25%-75% quartile: 0%-8%). Fifty-seven (93%) of 61 women had received at least 1 pre-SBRT marrow-taxing chemotherapy regimen for metastatic disease. Bone marrow V10 did not associate with hematological adverse events. In all, 15 grade 2 (25%) and 2 grade 3 (3%) fatigue symptoms were self-reported among the 61 women within the first 10 days post-therapy, with fatigue resolved spontaneously in all 17 women by 30 days post-therapy. Neutropenia was not observed. Three (5%) women had a grade 1 drop in hemoglobin level to <10.0 g/dL. Single grade 1, 2, and 3 thrombocytopenias were documented in 3 women. Conclusions: Abdominopelvic SBRT provided ablative radiation dose to cancer targets without increased bone marrow toxicity. Abdominopelvic SBRT for metastatic gynecologic malignancies warrants further study.

  4. Intraoperative 3D Ultrasonography for Image-Guided Neurosurgery

    NARCIS (Netherlands)

    Letteboer, Marloes Maria Johanna

    2004-01-01

    Stereotactic neurosurgery has evolved dramatically in recent years from the original rigid frame-based systems to the current frameless image-guided systems, which allow greater flexibility while maintaining sufficient accuracy. As these systems continue to evolve, more applications are found, and i

  5. Efficient and accurate stereotactic radiotherapy using flattening filter free beams and HexaPOD robotic tables

    DEFF Research Database (Denmark)

    Nielsen, Morten; Hansen, C. R.; Brink, C.

    2016-01-01

    Flattening filter free (FFF) high dose rate beam technique was introduced for brain stereotactic radiosurgery (SRS) and lung Stereotactic Body Radiotherapy (SBRT). Furthermore, a HexaPOD treatment table was introduced for the brain SRS to enable correction of rotational setup errors. 19 filter fl...

  6. Integration and evaluation of a needle-positioning robot with volumetric microcomputed tomography image guidance for small animal stereotactic interventions

    Energy Technology Data Exchange (ETDEWEB)

    Waspe, Adam C.; McErlain, David D.; Pitelka, Vasek; Holdsworth, David W.; Lacefield, James C.; Fenster, Aaron [Biomedical Engineering Graduate Program and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada); Department of Medical Biophysics and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada); Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario N6A 5C1 (Canada); Biomedical Engineering Graduate Program, Department of Medical Biophysics, Department of Medical Imaging, Department of Surgery, and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada); Biomedical Engineering Graduate Program, Department of Electrical and Computer Engineering, Department of Medical Biophysics, and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada); Biomedical Engineering Graduate Program, Department of Medical Biophysics, Department of Medical Imaging, and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada)

    2010-04-15

    Purpose: Preclinical research protocols often require insertion of needles to specific targets within small animal brains. To target biologically relevant locations in rodent brains more effectively, a robotic device has been developed that is capable of positioning a needle along oblique trajectories through a single burr hole in the skull under volumetric microcomputed tomography (micro-CT) guidance. Methods: An x-ray compatible stereotactic frame secures the head throughout the procedure using a bite bar, nose clamp, and ear bars. CT-to-robot registration enables structures identified in the image to be mapped to physical coordinates in the brain. Registration is accomplished by injecting a barium sulfate contrast agent as the robot withdraws the needle from predefined points in a phantom. Registration accuracy is affected by the robot-positioning error and is assessed by measuring the surface registration error for the fiducial and target needle tracks (FRE and TRE). This system was demonstrated in situ by injecting 200 {mu}m tungsten beads into rat brains along oblique trajectories through a single burr hole on the top of the skull under micro-CT image guidance. Postintervention micro-CT images of each skull were registered with preintervention high-field magnetic resonance images of the brain to infer the anatomical locations of the beads. Results: Registration using four fiducial needle tracks and one target track produced a FRE and a TRE of 96 and 210 {mu}m, respectively. Evaluation with tissue-mimicking gelatin phantoms showed that locations could be targeted with a mean error of 154{+-}113 {mu}m. Conclusions: The integration of a robotic needle-positioning device with volumetric micro-CT image guidance should increase the accuracy and reduce the invasiveness of stereotactic needle interventions in small animals.

  7. Integration and evaluation of a needle-positioning robot with volumetric microcomputed tomography image guidance for small animal stereotactic interventions.

    Science.gov (United States)

    Waspe, Adam C; McErlain, David D; Pitelka, Vasek; Holdsworth, David W; Lacefield, James C; Fenster, Aaron

    2010-04-01

    Preclinical research protocols often require insertion of needles to specific targets within small animal brains. To target biologically relevant locations in rodent brains more effectively, a robotic device has been developed that is capable of positioning a needle along oblique trajectories through a single burr hole in the skull under volumetric microcomputed tomography (micro-CT) guidance. An x-ray compatible stereotactic frame secures the head throughout the procedure using a bite bar, nose clamp, and ear bars. CT-to-robot registration enables structures identified in the image to be mapped to physical coordinates in the brain. Registration is accomplished by injecting a barium sulfate contrast agent as the robot withdraws the needle from predefined points in a phantom. Registration accuracy is affected by the robot-positioning error and is assessed by measuring the surface registration error for the fiducial and target needle tracks (FRE and TRE). This system was demonstrated in situ by injecting 200 microm tungsten beads into rat brains along oblique trajectories through a single burr hole on the top of the skull under micro-CT image guidance. Postintervention micro-CT images of each skull were registered with preintervention high-field magnetic resonance images of the brain to infer the anatomical locations of the beads. Registration using four fiducial needle tracks and one target track produced a FRE and a TRE of 96 and 210 microm, respectively. Evaluation with tissue-mimicking gelatin phantoms showed that locations could be targeted with a mean error of 154 +/- 113 microm. The integration of a robotic needle-positioning device with volumetric micro-CT image guidance should increase the accuracy and reduce the invasiveness of stereotactic needle interventions in small animals.

  8. Registration of a needle-positioning robot to high-resolution 3D ultrasound and computed tomography for image-guided interventions in small animals

    Science.gov (United States)

    Waspe, Adam C.; Lacefield, James C.; Holdsworth, David W.; Fenster, Aaron

    2008-03-01

    Preclinical research often requires the delivery of biological substances to specific locations in small animals. Guiding a needle to targets in small animals with an error animal imaging systems. Both techniques involve moving the needle to predetermined robot coordinates and determining corresponding needle locations in image coordinates. Registration accuracy will therefore be affected by the robot positioning error and is assessed by measuring the target registration error (TRE). A point-based registration between robot and micro-ultrasound coordinates was accomplished by attaching a fiducial phantom onto the needle. A TRE of 145 μm was achieved when moving the needle to a set of robot coordinates and registering the coordinates to needle tip locations determined from ultrasound fiducial measurements. Registration between robot and micro-CT coordinates was accomplished by injecting barium sulfate into tracks created when the robot withdraws the needle from a phantom. Points along cross-sectional slices of the segmented needle tracks were determined using an intensity-weighted centroiding algorithm. A minimum distance TRE of 194 +/- 18 μm was achieved by registering centroid points to robot trajectories using the iterative closest point (ICP) algorithm. Simulations, incorporating both robot and ultrasound fiducial localization errors, verify that robot error is a significant component of the experimental registration. Simulations of micro-CT to robot ICP registration similarly agree with the experimental results. Both registration techniques produce a TRE < 200 μm, meeting design specification.

  9. Intracranial depth electrodes implantation in the era of image-guided surgery

    Directory of Open Access Journals (Sweden)

    Ricardo Silva Centeno

    2011-08-01

    Full Text Available The advent of modern image-guided surgery has revolutionized depth electrode implantation techniques. Stereoelectroencephalography (SEEG, introduced by Talairach in the 1950s, is an invasive method for three-dimensional analysis on the epileptogenic zone based on the technique of intracranial implantation of depth electrodes. The aim of this article is to discuss the principles of SEEG and their evolution from the Talairach era to the image-guided surgery of today, along with future prospects. Although the general principles of SEEG have remained intact over the years, the implantation of depth electrodes, i.e. the surgical technique that enables this method, has undergone tremendous evolution over the last three decades, due the advent of modern imaging techniques, computer systems and new stereotactic techniques. The use of robotic systems, the constant evolution of imaging and computing techniques and the use of depth electrodes together with microdialysis probes will open up enormous prospects for applying depth electrodes and SEEG both for investigative use and for therapeutic use. Brain stimulation of deep targets and the construction of "smart" electrodes may, in the near future, increase the need to use this method.

  10. Real-time Needle Steering in Response to Rolling Vein Deformation by a 9-DOF Image-Guided Autonomous Venipuncture Robot.

    Science.gov (United States)

    Chen, Alvin I; Balter, Max L; Maguire, Timothy J; Yarmush, Martin L

    2015-01-01

    Venipuncture is the most common invasive medical procedure performed in the United States and the number one cause of hospital injury. Failure rates are particularly high in pediatric and elderly patients, whose veins tend to deform, move, or roll as the needle is introduced. To improve venipuncture accuracy in challenging patient populations, we have developed a portable device that autonomously servos a needle into a suitable vein under image guidance. The device operates in real time, combining near-infrared and ultrasound imaging, computer vision software, and a 9 degrees-of-freedom robot that servos the needle. In this paper, we present the kinematic and mechanical design of the latest generation robot. We then investigate in silico and in vitro the mechanics of vessel rolling and deformation in response to needle insertions performed by the robot. Finally, we demonstrate how the robot can make real-time adjustments under ultrasound image guidance to compensate for subtle vessel motions during venipuncture.

  11. 2D-3D radiograph to cone-beam computed tomography (CBCT) registration for C-arm image-guided robotic surgery.

    Science.gov (United States)

    Liu, Wen Pei; Otake, Yoshito; Azizian, Mahdi; Wagner, Oliver J; Sorger, Jonathan M; Armand, Mehran; Taylor, Russell H

    2015-08-01

    C-arm radiographs are commonly used for intraoperative image guidance in surgical interventions. Fluoroscopy is a cost-effective real-time modality, although image quality can vary greatly depending on the target anatomy. Cone-beam computed tomography (CBCT) scans are sometimes available, so 2D-3D registration is needed for intra-procedural guidance. C-arm radiographs were registered to CBCT scans and used for 3D localization of peritumor fiducials during a minimally invasive thoracic intervention with a da Vinci Si robot. Intensity-based 2D-3D registration of intraoperative radiographs to CBCT was performed. The feasible range of X-ray projections achievable by a C-arm positioned around a da Vinci Si surgical robot, configured for robotic wedge resection, was determined using phantom models. Experiments were conducted on synthetic phantoms and animals imaged with an OEC 9600 and a Siemens Artis zeego, representing the spectrum of different C-arm systems currently available for clinical use. The image guidance workflow was feasible using either an optically tracked OEC 9600 or a Siemens Artis zeego C-arm, resulting in an angular difference of Δθ:∼ 30°. The two C-arm systems provided TRE mean ≤ 2.5 mm and TRE mean ≤ 2.0 mm, respectively (i.e., comparable to standard clinical intraoperative navigation systems). C-arm 3D localization from dual 2D-3D registered radiographs was feasible and applicable for intraoperative image guidance during da Vinci robotic thoracic interventions using the proposed workflow. Tissue deformation and in vivo experiments are required before clinical evaluation of this system.

  12. Image-guided neurosurgery--state of the art and outlook.

    Science.gov (United States)

    Samii, M; Brinker, T; Samii, A

    1999-09-03

    The surgical possibilities of image guided neurosurgery are presented and critically reviewed. Image guided neurosurgery may enable neurosurgeons to work more precisely than before, and thus reduce mortality and morbidity. However, before the technology achieves widespread acceptance, technical standards must be developed, the intraoperative localisation technology improved, and clinical indications and the cost/benefit ratio clarified. Nevertheless, image guided neurosurgery appears to herald an exciting future in which virtual reality and robotic surgery will emerge as modern techniques.

  13. Imaging-guided thoracoscopic resection of a ground-glass opacity lesion in a hybrid operating room equipped with a robotic C-arm CT system.

    Science.gov (United States)

    Hsieh, Chen-Ping; Hsieh, Ming-Ju; Fang, Hsin-Yueh; Chao, Yin-Kai

    2017-05-01

    The intraoperative identification of small pulmonary nodules through video-assisted thoracoscopic surgery remains challenging. Although preoperative CT-guided nodule localization is commonly used to detect tumors during video-assisted thoracoscopic surgery (VATS), this approach carries inherent risks. We report the case of a patient with stage I lung cancer presenting as an area of ground-glass opacity (GGO) in the right upper pulmonary lobe. He successfully underwent a single-stage, CT-guided localization and removal of the pulmonary nodule within a hybrid operating room (OR) equipped with a robotic C-arm.

  14. Image-guided robot-assisted prostate ablation using water jet-hydrodissection: initial study of a novel technology for benign prostatic hyperplasia.

    Science.gov (United States)

    Faber, Kenneth; de Abreu, Andre Luis Castro; Ramos, Patrick; Aljuri, Nikolai; Mantri, Surag; Gill, Inderbir; Ukimura, Osamu; Desai, Mihir

    2015-01-01

    To evaluate the safety and efficacy of a novel robotic tissue ablation system (PROCEPT Aquablation(™) System), in performing prostate ablation in a survival canine model. This novel technology uses a high-velocity saline stream that aims to selectively ablate prostatic glandular tissue while sparing collagenous structures such as blood vessels and capsule. Once the ablation is complete, a laser beam is captured by a low-pressure water jet to produce surface hemostasis. The extent and depth of ablation is predetermined by endoscopic and transrectal ultrasonography guidance. The procedure was performed in eight noncastrated male beagles aged 6 years or older (Acute 2, Chronic 6) through a previously created perineal urethrostomy. Aquablation time ranged from 40 to 84 seconds (mean 60.5 sec). There was no active bleeding in any of the dogs during or after Aquablation. Water jet-guided laser coagulation was used for purposes of monitoring its safety and efficacy. Five of the six dogs reached the predetermined 6-week mark. Complications included two dogs with infection successfully treated with antibiotics, a false passage created during catheter placement, and two bladder neck perforations (from mechanical insertion), one leading to euthanasia. Histologic evaluation at 6 weeks revealed a normal cellular architecture and full reepithelialization of the treatment cavity. We report the initial survival data in the animal model of a novel robotic device developed for managing symptomatic benign prostatic hyperplasia (BPH). Aquablation produces ablation of adenomatous elements while preserving collagenous structures and is a promising technology for surgical management of symptomatic BPH.

  15. Image-guided radiation therapy; Bildgefuehrte Strahlentherapie

    Energy Technology Data Exchange (ETDEWEB)

    Boda-Heggemann, J.; Wertz, H.; Blessing, M.; Wenz, F.; Lohr, F. [Universitaetsmedizin Mannheim, Medizinische Fakultaet Mannheim der Universitaet Heidelberg, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany); Guckenberger, M. [Universitaetsklinikum Wuerzburg, Klinik fuer Strahlentherapie, Wuerzburg (Germany); Ganswindt, U.; Belka, C. [Klinikum der Ludwig-Maximilians-Universitaet, Klinik fuer Strahlentherapie und Radioonkologie, Muenchen (Germany); Fuss, M. [Oregon Health and Science University, Program in Image-guided Radiation Therapy, Department of Radiation Medicine, Portland, OR (United States)

    2012-03-15

    Radiotherapy technology has improved rapidly over the past two decades. New imaging modalities, such as positron emission (computed) tomography (PET, PET-CT) and high-resolution morphological and functional magnetic resonance imaging (MRI) have been introduced into the treatment planning process. Image-guided radiation therapy (IGRT) with 3D soft tissue depiction directly imaging target and normal structures, is currently replacing patient positioning based on patient surface markers, frame-based intracranial and extracranial stereotactic treatment and partially also 2D field verification methods. On-line 3D soft tissue-based position correction unlocked the full potential of new delivery techniques, such as intensity-modulated radiotherapy, by safely delivering highly conformal dose distributions that facilitate dose escalation and hypofractionation. These strategies have already resulted in better clinical outcomes, e.g. in prostate and lung cancer and are expected to further improve radiotherapy results. (orig.) [German] Die Strahlentherapie hat in den vergangenen 2 Dekaden von zahlreichen technischen Entwicklungen profitiert. Neue Bildgebungsmodalitaeten wie Positronenemissionstomographie (PET, PET/CT) und hochaufloesende morphologische und funktionelle MR-Sequenzen wurden in den Bestrahlungsplanungsprozess integriert. Die bildgesteuerte Strahlentherapie (''image-guided radiation therapy'', IGRT) ermoeglicht mittlerweile unmittelbar am Beschleuniger auch die 3-D-Darstellung von Weichgewebetumoren und ersetzt die Patientenpositionierung mittels Hautmarkern, rahmenbasierten stereotaktischen Verfahren im Kopf- und Koerperstamm und teilweise auch die 2-D-Verifikation der Bestrahlungsfelder. IGRT gestattet die Realisierung des vollen Potenzials fortgeschrittener Bestrahlungstechniken wie der intensitaetsmodulierten Strahlentherapie, mit deren Hilfe hochkonformale Dosisverteilungen realisiert werden koennen. Diese Strategien haben zu verbesserten

  16. [Image-guided stereotaxic biopsy of central nervous system lesions].

    Science.gov (United States)

    Nasser, J A; Confort, C I; Ferraz, A; Esperança, J C; Duarte, F

    1998-06-01

    In a series of 44 image guided stereotactic biopsy from August 1995 until March 1997, findings were as follows (frequency order). Tumors, glioblastoma was the most frequent. Primary lymphoma and other conditions associated to AIDS. Metastasis, three cases, Vasculites, two cases, Arachnoid cyst, Creutzfeldt-Jakob, cortical degeneration, inespecific calcification (one case each). The age varied from 1 to 83 years. Forty one lesions were supratentorial, two infratentorial, and one was outside the brain (dura and skull) and we used stereotaxy to localize it. There was no mortality and morbidity was 2.3%. The literature is reviewed. We conclude that this procedure is safe and highly diagnostic.

  17. Image-guided breast biopsy: state-of-the-art

    Energy Technology Data Exchange (ETDEWEB)

    O' Flynn, E.A.M., E-mail: lizoflynn@doctors.org.u [South East London Breast Screening Programme and National Breast Screening Training Centre, Kings College Hospital NHS Foundation Trust, London SE5 9RS (United Kingdom); Wilson, A.R.M.; Michell, M.J. [South East London Breast Screening Programme and National Breast Screening Training Centre, Kings College Hospital NHS Foundation Trust, London SE5 9RS (United Kingdom)

    2010-04-15

    Percutaneous image-guided breast biopsy is widely practised to evaluate predominantly non-palpable breast lesions. There has been steady development in percutaneous biopsy techniques. Fine-needle aspiration cytology was the original method of sampling, followed in the early 1990s by large core needle biopsy. The accuracy of both has been improved by ultrasound and stereotactic guidance. Larger bore vacuum-assisted biopsy devices became available in the late 1990s and are now commonplace in most breast units. We review the different types of breast biopsy devices currently available together with various localization techniques used, focusing on their advantages, limitations and current controversial clinical management issues.

  18. Is robotic arm stereotactic body radiation therapy “virtual high dose ratebrachytherapy” for prostate cancer? An analysis of comparative effectiveness using published data [corrected].

    Science.gov (United States)

    Zaorsky, Nicholas George; Hurwitz, Mark D; Dicker, Adam P; Showalter, Timothy N; Den, Robert B

    2015-05-01

    High-dose rate brachytherapy (HDR-BT) monotherapy and robotic arm (i.e., CyberKnife) stereotactic body radiation therapy (SBRT) are emerging technologies that have become popular treatment options for prostate cancer. Proponents of both HDR-BT monotherapy and robotic arm SBRT claim that these modalities are as efficacious as intensity-modulated radiation therapy in treating prostate cancer. Moreover, proponents of robotic arm SBRT believe it is more effective than HDR-BT monotherapy because SBRT is non-invasive, touting it as 'virtual HDR-BT.' We perform a comparative effective analysis of the two technologies. The tumor control rates and toxicities of HDR-BT monotherapy and robotic arm SBRT are promising. However, at present, it would be inappropriate to state that HDR-BT monotherapy and robotic arm SBRT are as efficacious or effective as other treatment modalities for prostate cancer, which have stronger foundations of evidence. Studies reporting on these technologies have relatively short follow-up time, few patients and are largely retrospective.

  19. 三维可视化图像引导立体定位脑干及松果体区病灶活检术的研究%The technical report of three-dimension visualized image-guided stereotactic biopsy for lesions in pineal region and brain stem

    Institute of Scientific and Technical Information of China (English)

    王亚明; 于新; 李志超; 惠瑞; 刘锐; 尹丰; 张雷鸣; 程岗; 张剑宁

    2015-01-01

    Objective To investigate the methodology,technical essential and significance of threedimension visualized image-guided stereotactic biopsy (SB) for lesions in pineal region and brain stem.Methods A total of 88 cases of lesions in pineal region and brain stem underwent image-guided SB in our department were retrospectively studied.Frame-based and CAS-2 type frameless SBs were performed in 57 and 31 cases respectively.Pre-biopsy three-dimension visualized image reconstruction was performed by SB planning software and the structure related to possible trajectory in each image slice was confirmed.The most suitable trajectory was selected accordingly.For lesions in pineal region,anterior-frontal trans-tentorium cerebella hiatus trajectory for avoiding tentorial margin was used.For lesions in mesencephalon,posteriorfrontal trans-lateral ventrical-thalamus trajectory via the vertical axis of brain stem was used.For pontal lesions,supra-occipital trans-pedunculus cerebellaris medius trajectory was used.Results Histological diagnosis was established in all 88 cases,which gave a high diagnostic yield (100%).Fifty-six lesions (64%) located in brain stem (middle brain and pons) and 32 (36%) in pineal region.In 56 brain stem lesions,there were 38 cases (68%) of glioma,3(5%) lymphoma,2(4%) neurodegenerative disease,6 (11%) multiple sclerosis and tumefactive demyelinating lesion,2 (4%) non-specific inflammation,2 (4%)brain infarct,2(4%) brain metastases,and 1 (2%) radiation necrosis.For lesions in pineal region,there were 18 cases (56%) of germ cell tumor,4(13%) glioma,9 (28%) pineal cell tumor,and 1 (3%) Wemicke encephalopathy.One case (1%) died of biopsy-related hemorrhage.The neurological deficits became severe because of hemorrhage in 5 cases,the medical treatment was adopted in 3 cases (3%)and drainage in 2 (2%).Conclusions Stereotactic biopsy for lesions in pineal region and brain stem was a safe and effective procedure that could help

  20. Image guidance quality assurance of a G4 CyberKnife robotic stereotactic radiosurgery system

    Energy Technology Data Exchange (ETDEWEB)

    Pantelis, E; Antypas, C [CyberKnife center, Iatropolis-Magnitiki Tomografia, Ethnikis Antistaseos 54-56, Chalandri, 152 31, Athens (Greece); Petrokokkinos, L [University of Athens, Physics Department, Nuclear and Particle Section, Panepistimioupolis, Ilisia, Athens (Greece)], E-mail: vpantelis@phys.uoa.gr

    2009-05-15

    The image guidance of a CyberKnife robotic radiosurgery system was quality controlled, including the overall performance of the target locating subsystem and the performance of the x-ray generators and flat panel digital cameras subcomponents. Accuracy and precision of the kV and exposure time settings of the x-ray generators, linearity of the x-ray output, spatial resolution and geometrical distortion of the acquired x-ray images were measured. Total accuracy and precision of the target locating subsystem in defining the position of an anthropomorphic head and neck phantom placed on treatment couch was also measured. Accuracy and precision of the kV as well as exposure time settings and linearity of the x-ray output were found within the acceptance limits suggested in diagnostic radiology. The acquired x-ray images were found to depict the shapes of the imaging objects without any geometrical distortion, being able to resolve differences in the features of imaging objects with critical frequency of 1.3 lp/mm and 1.5 lp/mm for camera A and B, respectively. Total target locating system accuracy was found within 0.2 mm and 0.2 deg. in translations and rotations, respectively. Corresponding precision was found lower than 0.5%. These findings render the target locating subsystem of the CyberKnife capable of accurately registering the patient to treatment position and monitoring patient's movement during treatment delivery.

  1. Image guidance quality assurance of a G4 CyberKnife robotic stereotactic radiosurgery system

    Science.gov (United States)

    Pantelis, E.; Petrokokkinos, L.; Antypas, C.

    2009-05-01

    The image guidance of a CyberKnife robotic radiosurgery system was quality controlled, including the overall performance of the target locating subsystem and the performance of the x-ray generators and flat panel digital cameras subcomponents. Accuracy and precision of the kV and exposure time settings of the x-ray generators, linearity of the x-ray output, spatial resolution and geometrical distortion of the acquired x-ray images were measured. Total accuracy and precision of the target locating subsystem in defining the position of an anthropomorphic head and neck phantom placed on treatment couch was also measured. Accuracy and precision of the kV as well as exposure time settings and linearity of the x-ray output were found within the acceptance limits suggested in diagnostic radiology. The acquired x-ray images were found to depict the shapes of the imaging objects without any geometrical distortion, being able to resolve differences in the features of imaging objects with critical frequency of 1.3 lp/mm and 1.5 lp/mm for camera A and B, respectively. Total target locating system accuracy was found within 0.2 mm and 0.2° in translations and rotations, respectively. Corresponding precision was found lower than 0.5%. These findings render the target locating subsystem of the CyberKnife capable of accurately registering the patient to treatment position and monitoring patient's movement during treatment delivery.

  2. Technical Note: Evaluation of the systematic accuracy of a frameless, multiple image modality guided, linear accelerator based stereotactic radiosurgery system

    Energy Technology Data Exchange (ETDEWEB)

    Wen, N., E-mail: nwen1@hfhs.org; Snyder, K. C.; Qin, Y.; Li, H.; Siddiqui, M. S.; Chetty, I. J. [Department of Radiation Oncology, Henry Ford Health System, 2799 West Brand Boulevard, Detroit, Michigan 48202 (United States); Scheib, S. G.; Schmelzer, P. [Varian Medical System, Täfernstrasse 7, Dättwil AG 5405 (Switzerland)

    2016-05-15

    Purpose: To evaluate the total systematic accuracy of a frameless, image guided stereotactic radiosurgery system. Methods: The localization accuracy and intermodality difference was determined by delivering radiation to an end-to-end prototype phantom, in which the targets were localized using optical surface monitoring system (OSMS), electromagnetic beacon-based tracking (Calypso®), cone-beam CT, “snap-shot” planar x-ray imaging, and a robotic couch. Six IMRT plans with jaw tracking and a flattening filter free beam were used to study the dosimetric accuracy for intracranial and spinal stereotactic radiosurgery treatment. Results: End-to-end localization accuracy of the system evaluated with the end-to-end phantom was 0.5 ± 0.2 mm with a maximum deviation of 0.9 mm over 90 measurements (including jaw, MLC, and cone measurements for both auto and manual fusion) for single isocenter, single target treatment, 0.6 ± 0.4 mm for multitarget treatment with shared isocenter. Residual setup errors were within 0.1 mm for OSMS, and 0.3 mm for Calypso. Dosimetric evaluation based on absolute film dosimetry showed greater than 90% pass rate for all cases using a gamma criteria of 3%/1 mm. Conclusions: The authors’ experience demonstrates that the localization accuracy of the frameless image-guided system is comparable to robotic or invasive frame based radiosurgery systems.

  3. Design of an MRI-compatible robotic stereotactic device for minimally invasive interventions in the breast.

    Science.gov (United States)

    Larson, Blake T; Erdman, Arthur G; Tsekos, Nikolaos V; Yacoub, Essa; Tsekos, Panagiotis V; Koutlas, Ioannis G

    2004-08-01

    The objective of this work was to develop a robotic device to perform biopsy and therapeutic interventions in the breast with real-time magnetic resonance imaging (MRI) guidance. The device was designed to allow for (i) stabilization of the breast by compression, (ii) definition of the interventional probe trajectory by setting the height and pitch of a probe insertion apparatus, and (iii) positioning of an interventional probe by setting the depth of insertion. The apparatus is fitted with five computer-controlled degrees of freedom for delivering an interventional procedure. The entire device is constructed of MR compatible materials, i.e. nonmagnetic and non-conductive, to eliminate artifacts and distortion of the MR images. The apparatus is remotely controlled by means of ultrasonic motors and a graphical user interface, providing real-time MR-guided planning and monitoring of the operation. Joint motion measurements found probe placement in less than 50 s and sub-millimeter repeatability of the probe tip for same-direction point-to-point movements. However, backlash in the rotation joint may incur probe tip positional errors of up to 5 mm at a distance of 40 mm from the rotation axis, which may occur for women with large breasts. The imprecision caused by this backlash becomes negligible as the probe tip nears the rotation axis. Real-time MR-guidance will allow the physician to correct this error Compatibility of the device within the MR environment was successfully tested on a 4 Tesla MR human scanner

  4. Image guided percutaneous splenic interventions

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Mandeep [Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India)], E-mail: mandykang2005@yahoo.com; Kalra, Naveen; Gulati, Madhu; Lal, Anupam; Kochhar, Rohit [Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India); Rajwanshi, Arvind [Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India)

    2007-10-15

    Aim: The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. Materials and methods: We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n = 93) or CT (n = 2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n = 78) and aspiration (n = 10) or percutaneous catheter drainage of a splenic abscess (n = 7). Results: Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. Conclusions: Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery.

  5. Image guided prostate cancer treatments

    Energy Technology Data Exchange (ETDEWEB)

    Bard, Robert L. [Bard Cancer Center, Biofoundation for Angiogenesis Research and Development, New York, NY (United States); Fuetterer, Jurgen J. [Radboud Univ. Nijmegen, Medical Centre (Netherlands). Dept. of Radiology; Sperling, Dan (ed.) [Sperling Prostate Center, Alpha 3TMRI, New York, NY (United States)

    2014-07-01

    Systematic overview of the application of ultrasound and MRI in the diagnosis and treatment of diseases of the lower urinary tract. Detailed information on image-guided therapies, including focused ultrasound, photodynamic therapy, and microwave and laser ablation. Numerous high-quality illustrations based on high-end equipment. Represents the state of the art in Non Invasive Imaging and Minimally Invasive Ablation Treatment (MIAT). Image-Guided Prostate Cancer Treatments is a comprehensive reference and practical guide on the technology and application of ultrasound and MRI in the male pelvis, with special attention to the prostate. The book is organized into three main sections, the first of which is devoted to general aspects of imaging and image-guided treatments. The second section provides a systematic overview of the application of ultrasound and MRI to the diagnosis and treatment of diseases of the lower urinary tract. Performance of the ultrasound and MRI studies is explained, and the normal and abnormal pathological anatomy is reviewed. Correlation with the ultrasound in the same plane is provided to assist in understanding the MRI sequences. Biopsy and interventional procedures, ultrasound-MRI fusion techniques, and image-guided therapies, including focused ultrasound, photodynamic therapy, microwave and laser ablation, are all fully covered. The third section focuses on securing treatment effectiveness and the use of follow-up imaging to ensure therapeutic success and detect tumor recurrence at an early stage, which is vital given that prompt focal treatment of recurrence is very successful. Here, particular attention is paid to the role of Doppler ultrasound and DCE-MRI technologies. This book, containing a wealth of high-quality illustrations based on high-end equipment, will acquaint beginners with the basics of prostate ultrasound and MRI, while more advanced practitioners will learn new skills, means of avoiding pitfalls, and ways of effectively

  6. Image-guided therapies in the treatment of hepatocellularcarcinoma: A multidisciplinary perspective

    Institute of Scientific and Technical Information of China (English)

    Jonathon Willatt; Kevin K Hannawa; Julie A Ruma; Timothy L Frankel; Dawn Owen; Pranab M Barman

    2015-01-01

    A multidisciplinary approach to the treatment ofpatients with unresectable hepatocellular carcinoma(HCC) has led to improvements in screening, detection,and treatments. Interventional techniques includethermal ablation, transarterial chemoembolization, andradioembolization whilst stereotactic body radiationtherapy also uses imaging to target the radiation. Bothsurvival rates and cure rates have improved markedlysince the introduction of these techniques. This reviewarticle describes the image guided techniques used forthe treatment of HCC.

  7. Image-guided therapies in the treatment of hepatocellular carcinoma: A multidisciplinary perspective.

    Science.gov (United States)

    Willatt, Jonathon; Hannawa, Kevin K; Ruma, Julie A; Frankel, Timothy L; Owen, Dawn; Barman, Pranab M

    2015-02-27

    A multidisciplinary approach to the treatment of patients with unresectable hepatocellular carcinoma (HCC) has led to improvements in screening, detection, and treatments. Interventional techniques include thermal ablation, transarterial chemoembolization, and radioembolization whilst stereotactic body radiation therapy also uses imaging to target the radiation. Both survival rates and cure rates have improved markedly since the introduction of these techniques. This review article describes the image guided techniques used for the treatment of HCC.

  8. Accuracy and feasibility of frameless stereotactic and robot-assisted CT-based puncture in interventional radiology. A comparative phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Stoffner, R.; Widmann, G.; Bale, R. [Radiologie, Medizinische Univ. Innsbruck (Austria); Augschoell, C. [Chirurgie, LKH Salzburg (Austria); Boehler, D. [LKH Salzburg (Austria)

    2009-09-15

    Purpose: To compare the accuracy of frameless stereotactic and robot-assisted puncture in vitro based on computed tomography (CT) imaging with a slice thickness of 1, 3, and 5 mm. Materials and Methods: 300 punctures were carried out with help of the Atlas aiming device guided by the optical navigation system Stealth Station TREONplus and 150 punctures were guided by the robotic assistance system Innomotion. Conically shaped rods were punctured with Kirschner wires. The accuracy was evaluated on the basis of control CTs by measuring the Euclidean distance between the wire tip and target and the normal distance between the target and wire. Results: With the Stealth Station a mean Euclidean distance of 1.94{+-}0.912, 2.2{+-}1.136, and 2.74{+-}1.166 mm at a slice thickness of 1, 3 and 5 mm, respectively, was reached. The mean normal distance was 1.64{+-}0.919, 1.84{+-}1.189, and 2.48{+-}1.196 mm, respectively. The Innomotion system resulted in a mean Euclidean distance of 1.69{+-}0.772, 1.91{+-}0.673, and 2.30{+-}0.881 mm, respectively, while the mean normal distance was (1.42{+-}0.78), 1.60{+-}0.733, and 1.98{+-}1.002 mm, respectively. A statistical significance between accuracies with both systems with 1 mm and 3 mm slices could not be detected (p > 0.05). At a slice thickness of 5 mm, the robot was significantly more accurate, but not as accurate as when using thinner slices (p < 0.05). The procedure time is longer for the Innomotion system ({proportional_to}30 vs. {proportional_to}18 min), and the practicability is higher with the Stealth Station. (orig.)

  9. Toward adaptive stereotactic robotic brachytherapy for prostate cancer: demonstration of an adaptive workflow incorporating inverse planning and an MR stealth robot.

    Science.gov (United States)

    Cunha, J Adam; Hsu, I-Chow; Pouliot, Jean; Roach Iii, Mack; Shinohara, Katsuto; Kurhanewicz, John; Reed, Galen; Stoianovici, Dan

    2010-08-01

    To translate any robot into a clinical environment, it is critical that the robot can seamlessly integrate with all the technology of a modern clinic. MRBot, an MR-stealth brachytherapy delivery device, was used in a closed-bore 3T MRI and a clinical brachytherapy cone beam CT suite. Targets included ceramic dummy seeds, MR-Spectroscopy-sensitive metabolite, and a prostate phantom. Acquired DICOM images were exported to planning software to register the robot coordinates in the imager's frame, contour and verify target locations, create dose plans, and export needle and seed positions to the robot. The coordination of each system element (imaging device, brachytherapy planning system, robot control, robot) was validated with a seed delivery accuracy of within 2 mm in both a phantom and soft tissue. An adaptive workflow was demonstrated by acquiring images after needle insertion and prior to seed deposition. This allows for adjustment if the needle is in the wrong position. Inverse planning (IPSA) was used to generate a seed placement plan and coordinates for ten needles and 29 seeds were transferred to the robot. After every two needles placed, an image was acquired. The placed seeds were identified and validated prior to placing the seeds in the next two needles. The ability to robotically deliver seeds to locations determined by IPSA and the ability of the system to incorporate novel needle patterns were demonstrated. Shown here is the ability to overcome this critical step. An adaptive brachytherapy workflow is demonstrated which integrates a clinical anatomy-based seed location optimization engine and a robotic brachytherapy device. Demonstration of this workflow is a key element of a successful translation to the clinic of the MRI stealth robotic delivery system, MRBot.

  10. Stereotactic radiosurgery - discharge

    Science.gov (United States)

    Gamma knife - discharge; Cyberknife - discharge; Stereotactic radiotherapy - discharge; Fractionated stereotactic radiotherapy - discharge; Cyclotrons - discharge; Linear accelerator - discharge; Lineacs - ...

  11. Image-guided endobronchial ultrasound

    Science.gov (United States)

    Higgins, William E.; Zang, Xiaonan; Cheirsilp, Ronnarit; Byrnes, Patrick; Kuhlengel, Trevor; Bascom, Rebecca; Toth, Jennifer

    2016-03-01

    Endobronchial ultrasound (EBUS) is now recommended as a standard procedure for in vivo verification of extraluminal diagnostic sites during cancer-staging bronchoscopy. Yet, physicians vary considerably in their skills at using EBUS effectively. Regarding existing bronchoscopy guidance systems, studies have shown their effectiveness in the lung-cancer management process. With such a system, a patient's X-ray computed tomography (CT) scan is used to plan a procedure to regions of interest (ROIs). This plan is then used during follow-on guided bronchoscopy. Recent clinical guidelines for lung cancer, however, also dictate using positron emission tomography (PET) imaging for identifying suspicious ROIs and aiding in the cancer-staging process. While researchers have attempted to use guided bronchoscopy systems in tandem with PET imaging and EBUS, no true EBUS-centric guidance system exists. We now propose a full multimodal image-based methodology for guiding EBUS. The complete methodology involves two components: 1) a procedure planning protocol that gives bronchoscope movements appropriate for live EBUS positioning; and 2) a guidance strategy and associated system graphical user interface (GUI) designed for image-guided EBUS. We present results demonstrating the operation of the system.

  12. Noncoplanar Beam Angle Class Solutions to Replace Time-Consuming Patient-Specific Beam Angle Optimization in Robotic Prostate Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Linda, E-mail: l.rossi@erasmusmc.nl; Breedveld, Sebastiaan; Aluwini, Shafak; Heijmen, Ben

    2015-07-15

    Purpose: To investigate development of a recipe for the creation of a beam angle class solution (CS) for noncoplanar prostate stereotactic body radiation therapy to replace time-consuming individualized beam angle selection (iBAS) without significant loss in plan quality, using the in-house “Erasmus-iCycle” optimizer for fully automated beam profile optimization and iBAS. Methods and Materials: For 30 patients, Erasmus-iCycle was first used to generate 15-, 20-, and 25-beam iBAS plans for a CyberKnife equipped with a multileaf collimator. With these plans, 6 recipes for creation of beam angle CSs were investigated. Plans of 10 patients were used to create CSs based on the recipes, and the other 20 to independently test them. For these tests, Erasmus-iCycle was also used to generate intensity modulated radiation therapy plans for the fixed CS beam setups. Results: Of the tested recipes for CS creation, only 1 resulted in 15-, 20-, and 25-beam noncoplanar CSs without plan deterioration compared with iBAS. For the patient group, mean differences in rectum D{sub 1cc}, V{sub 60GyEq}, V{sub 40GyEq}, and D{sub mean} between 25-beam CS plans and 25-beam plans generated with iBAS were 0.2 ± 0.4 Gy, 0.1% ± 0.2%, 0.2% ± 0.3%, and 0.1 ± 0.2 Gy, respectively. Differences between 15- and 20-beam CS and iBAS plans were also negligible. Plan quality for CS plans relative to iBAS plans was also preserved when narrower planning target volume margins were arranged and when planning target volume dose inhomogeneity was decreased. Using a CS instead of iBAS reduced the computation time by a factor of 14 to 25, mainly depending on beam number, without loss in plan quality. Conclusions: A recipe for creation of robust beam angle CSs for robotic prostate stereotactic body radiation therapy has been developed. Compared with iBAS, computation times decreased by a factor 14 to 25. The use of a CS may avoid long planning times without losses in plan quality.

  13. Analysis of tenth-value-layers for common shielding materials for a robotically mounted stereotactic radiosurgery machine.

    Science.gov (United States)

    Rodgers, James E

    2007-04-01

    Tenth-value-layers (TVLs) for a 6 MV stereotactic radiosurgery (SRS) x-ray beam have been computed using Monte Carlo methods for radiation transport simulation. The first and equilibrium TVLs were determined in the three most common building materials used in radiation therapy vault construction: ordinary concrete, lead, and steel (iron). In contrast to broad-beam 6 MV TVL data found in the literature, the SRS TVLs can change rapidly with the size of the radiation field incident on the barrier. This research has investigated characteristics of TVLs as a function of field size (diameter) at the barrier for all materials, with special attention given to the TVL properties in iron. The x-ray spectrum used to perform these simulations was generated for the CyberKnife accelerator with the BEAMnrc Monte Carlo code. Using this spectrum as input to the MCNP5 Monte Carlo code, predicted tissue-maximum-ratio (TMR) values for a 6-cm-diameter field (at 80 cm from the target) were benchmarked against measured TMR data. The MCNP5 code was used to simulate all barrier transmissions, keeping the standard error of each data point below 1% of the mean. Results compare very well with previous measured concrete TVLs and also with published broad-beam 6 MV TVL data for all three barrier materials.

  14. Optimizing MR imaging-guided navigation for focused ultrasound interventions in the brain

    Science.gov (United States)

    Werner, B.; Martin, E.; Bauer, R.; O'Gorman, R.

    2017-03-01

    MR imaging during transcranial MR imaging-guided Focused Ultrasound surgery (tcMRIgFUS) is challenging due to the complex ultrasound transducer setup and the water bolus used for acoustic coupling. Achievable image quality in the tcMRIgFUS setup using the standard body coil is significantly inferior to current neuroradiologic standards. As a consequence, MR image guidance for precise navigation in functional neurosurgical interventions using tcMRIgFUS is basically limited to the acquisition of MR coordinates of salient landmarks such as the anterior and posterior commissure for aligning a stereotactic atlas. Here, we show how improved MR image quality provided by a custom built MR coil and optimized MR imaging sequences can support imaging-guided navigation for functional tcMRIgFUS neurosurgery by visualizing anatomical landmarks that can be integrated into the navigation process to accommodate for patient specific anatomy.

  15. Intracranial stereotactic radiosurgery with an adapted linear accelerator vs. robotic radiosurgery: Comparison of dosimetric treatment plan quality.

    Science.gov (United States)

    Treuer, Harald; Hoevels, Moritz; Luyken, Klaus; Visser-Vandewalle, Veerle; Wirths, Jochen; Kocher, Martin; Ruge, Maximilian

    2015-06-01

    Stereotactic radiosurgery with an adapted linear accelerator (linac-SRS) is an established therapy option for brain metastases, benign brain tumors, and arteriovenous malformations. We intended to investigate whether the dosimetric quality of treatment plans achieved with a CyberKnife (CK) is at least equivalent to that for linac-SRS with circular or micromultileaf collimators (microMLC). A random sample of 16 patients with 23 target volumes, previously treated with linac-SRS, was replanned with CK. Planning constraints were identical dose prescription and clinical applicability. In all cases uniform optimization scripts and inverse planning objectives were used. Plans were compared with respect to coverage, minimal dose within target volume, conformity index, and volume of brain tissue irradiated with ≥ 10 Gy. Generating the CK plan was unproblematic with simple optimization scripts in all cases. With the CK plans, coverage, minimal target volume dosage, and conformity index were significantly better, while no significant improvement could be shown regarding the 10 Gy volume. Multiobjective comparison for the irradiated target volumes was superior in the CK plan in 20 out of 23 cases and equivalent in 3 out of 23 cases. Multiobjective comparison for the treated patients was superior in the CK plan in all 16 cases. The results clearly demonstrate the superiority of the irradiation plan for CK compared to classical linac-SRS with circular collimators and microMLC. In particular, the average minimal target volume dose per patient, increased by 1.9 Gy, and at the same time a 14% better conformation index seems to be an improvement with clinical relevance.

  16. 6DOF optical tracking system using afocal optics for image guided surgery

    Directory of Open Access Journals (Sweden)

    Chae You Seong

    2015-01-01

    Full Text Available Image guided surgery using medical robots is becoming popular these days. For image guided surgery, a tracking system is required to provide 6DOF information of patient coordinate, surgical instruments and medical robots used in surgery. To provide 6DOF information, a marker has to be attached to the target. However, it is hard to use many markers all together because the markers will take too much space in the surgical area. The tracking system proposed in this study utilizes down sized markers compared to traditional markers by using micro-engraved data-coded pattern with a lens instead of using geometrically specified marker spheres as a tracking target. A tracking system is developed that has a measurement area of 1m to 2.5m from the tracking system. Experiment has been done for surgical navigation using the proposed tracking system and a medical robot.

  17. Fast-MICP for frameless image-guided surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jiann-Der; Huang, Chung-Hsien; Wang, Sheng-Ta; Lin, Chung-Wei; Lee, Shin-Tseng [Department of Electrical Engineering, Chang Gung University, Tao-Yuan 333, Taiwan (China); Department of Medical Mechatronics, Chang Gung University, Tao-Yuan 333, Taiwan (China); Department of Neurosurgery and Medical Augmented Reality Research Center, Chang Gung Memorial Hospital, No. 199, Tunghwa Rd., Taipei 105, Taiwan (China)

    2010-09-15

    Purpose: In image-guided surgery (IGS) systems, image-to-physical registration is critical for reliable anatomical information mapping and spatial guidance. Conventional stereotactic frame-based or fiducial-based approaches provide accurate registration but are not patient-friendly. This study proposes a frameless cranial IGS system that uses computer vision techniques to replace the frame or fiducials with the natural features of the patient. Methods: To perform a cranial surgery with the proposed system, the facial surface of the patient is first reconstructed by stereo vision. Accuracy is ensured by capturing parallel-line patterns projected from a calibrated LCD projector. Meanwhile, another facial surface is reconstructed from preoperative computed tomography (CT) images of the patient. The proposed iterative closest point (ICP)-based algorithm [fast marker-added ICP (Fast-MICP)] is then used to register the two facial data sets, which transfers the anatomical information from the CT images to the physical space. Results: Experimental results reveal that the Fast-MICP algorithm reduces the computational cost of marker-added ICP (J.-D. Lee et al., ''A coarse-to-fine surface registration algorithm for frameless brain surgery,'' in Proceedings of International Conference of the IEEE Engineering in Medicine and Biology Society, 2007, pp. 836-839) to 10% and achieves comparable registration accuracy, which is under 3 mm target registration error (TRE). Moreover, two types of optical-based spatial digitizing devices can be integrated for further surgical navigation. Anatomical information or image-guided surgical landmarks can be projected onto the patient to obtain an immersive augmented reality environment. Conclusion: The proposed frameless IGS system with stereo vision obtains TRE of less than 3 mm. The proposed Fast-MICP registration algorithm reduces registration time by 90% without compromising accuracy.

  18. Robotic stereotactic body radiation therapy for elderly medically inoperable early-stage non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Karam SD

    2013-08-01

    Full Text Available Sana D Karam,1 Zachary D Horne,1 Robert L Hong,1,2 Nimrah Baig,1 Gregory J Gagnon,4 Don McRae,2 David Duhamel,3 Nadim M Nasr1,21Department of Radiation Oncology, Georgetown University Hospital, Washington, DC, USA; 2Department of Radiation Oncology, Virginia Hospital Center, Arlington, VA, USA; 3Department of Pulmonary/Critical Care Medicine, Virginia Hospital Center, Arlington, VA, USA; 4Department of Radiation Oncology, Frederick Memorial Hospital, Frederick, MD, USAIntroduction: Stereotactic body radiation therapy (SBRT is being increasingly applied in the treatment of non-small cell lung cancer (NSCLC because of its high local efficacy. This study aims to examine survival outcomes in elderly patients with inoperable stage I NSCLC treated with SBRT.Methods: A total of 31 patients with single lesions treated with fractionated SBRT from 2008 to 2011 were retrospectively analyzed. A median prescribed dose of 48 Gy was delivered to the prescription isodose line, over a median of four treatments. The median biologically effective dose (BED was 105.6 (range 37.50–180, and the median age was 73 (65–90 years. No patient received concurrent chemotherapy.Results: With a median follow up of 13 months (range, 4–40 months, the actuarial median overall survival (OS and progression-free survival (PFS were 32 months, and 19 months, respectively. The actuarial median local control (LC time was not reached. The survival outcomes at median follow up of 13 months were 80%, 68%, and 70% for LC, PFS, and OS, respectively. Univariate analysis revealed a BED of >100 Gy was associated with improved LC rates (P = 0.02, while squamous cell histology predicted for worse LC outcome at median follow up time of 13 months (P = 0.04. Increased tumor volume was a worse prognostic indicator of both LC and OS outcomes (P < 0.05. Finally, female gender was a better prognostic factor for OS than male gender (P = 0.006. There were no prognostic indicators of PFS that reached

  19. Stereotactic radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Leksell, L. (Karolinska Sjukhuset, Stockholm (Sweden))

    1983-09-01

    The development and scope of stereotactic radiosurgery is described. The technique, which combines well with the latest diagnostic methods, has already proved a safe and effective way of treating inaccessible cerebral lesions and in particular small arteriovenous malformations, acoustic neuroma and the solid component of craniopharyngioma, as well as playing an increasingly useful role in the therapy of pituitary adenoma.

  20. Intracranial stereotactic radiosurgery with an adapted linear accelerator vs. robotic radiosurgery. Comparison of dosimetric treatment plan quality

    Energy Technology Data Exchange (ETDEWEB)

    Treuer, Harald; Hoevels, Moritz; Luyken, Klaus; Visser-Vandewalle, Veerle; Wirths, Jochen; Ruge, Maximilian [University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); Kocher, Martin [University Hospital Cologne, Department of Radiotherapy, Cologne (Germany)

    2014-11-22

    Stereotactic radiosurgery with an adapted linear accelerator (linac-SRS) is an established therapy option for brain metastases, benign brain tumors, and arteriovenous malformations. We intended to investigate whether the dosimetric quality of treatment plans achieved with a CyberKnife (CK) is at least equivalent to that for linac-SRS with circular or micromultileaf collimators (microMLC). A random sample of 16 patients with 23 target volumes, previously treated with linac-SRS, was replanned with CK. Planning constraints were identical dose prescription and clinical applicability. In all cases uniform optimization scripts and inverse planning objectives were used. Plans were compared with respect to coverage, minimal dose within target volume, conformity index, and volume of brain tissue irradiated with ≥ 10 Gy. Generating the CK plan was unproblematic with simple optimization scripts in all cases. With the CK plans, coverage, minimal target volume dosage, and conformity index were significantly better, while no significant improvement could be shown regarding the 10 Gy volume. Multiobjective comparison for the irradiated target volumes was superior in the CK plan in 20 out of 23 cases and equivalent in 3 out of 23 cases. Multiobjective comparison for the treated patients was superior in the CK plan in all 16 cases. The results clearly demonstrate the superiority of the irradiation plan for CK compared to classical linac-SRS with circular collimators and microMLC. In particular, the average minimal target volume dose per patient, increased by 1.9 Gy, and at the same time a 14 % better conformation index seems to be an improvement with clinical relevance. (orig.) [German] Stereotaktische Radiochirurgie mit einem adaptierten Linearbeschleuniger (Linac-SRS) ist eine erfolgreiche und etablierte Therapieoption fuer Hirnmetastasen, benigne Hirntumoren und arteriovenoese Malformationen. Ziel war es, zu untersuchen, ob die mit einem CyberKnife (CK) erreichbare

  1. Robotics

    Science.gov (United States)

    Popov, E. P.; Iurevich, E. I.

    The history and the current status of robotics are reviewed, as are the design, operation, and principal applications of industrial robots. Attention is given to programmable robots, robots with adaptive control and elements of artificial intelligence, and remotely controlled robots. The applications of robots discussed include mechanical engineering, cargo handling during transportation and storage, mining, and metallurgy. The future prospects of robotics are briefly outlined.

  2. Urologic robots and future directions

    OpenAIRE

    Mozer, Pierre; Troccaz, Jocelyne; Stoianovici, Dan

    2008-01-01

    International audience; PURPOSE OF REVIEW: Robot-assisted laparoscopic surgery in urology has gained immense popularity with the daVinci system, but a lot of research teams are working on new robots. The purpose of this study is to review current urologic robots and present future development directions. RECENT FINDINGS: Future systems are expected to advance in two directions: improvements of remote manipulation robots and developments of image-guided robots. SUMMARY: The final goal of robot...

  3. Comparison of 3D and 4D Monte Carlo optimization in robotic tracking stereotactic body radiotherapy of lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Mark K.H. [Tuen Mun Hospital, Department of Clinical Oncology, Hong Kong (S.A.R) (China); Werner, Rene [The University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg (Germany); Ayadi, Miriam [Leon Berard Cancer Center, Department of Radiation Oncology, Lyon (France); Blanck, Oliver [University Clinic of Schleswig-Holstein, Department of Radiation Oncology, Luebeck (Germany); CyberKnife Center Northern Germany, Guestrow (Germany)

    2014-09-20

    To investigate the adequacy of three-dimensional (3D) Monte Carlo (MC) optimization (3DMCO) and the potential of four-dimensional (4D) dose renormalization (4DMC{sub renorm}) and optimization (4DMCO) for CyberKnife (Accuray Inc., Sunnyvale, CA) radiotherapy planning in lung cancer. For 20 lung tumors, 3DMCO and 4DMCO plans were generated with planning target volume (PTV{sub 5} {sub mm}) = gross tumor volume (GTV) plus 5 mm, assuming 3 mm for tracking errors (PTV{sub 3} {sub mm}) and 2 mm for residual organ deformations. Three fractions of 60 Gy were prescribed to ≥ 95 % of the PTV{sub 5} {sub mm}. Each 3DMCO plan was recalculated by 4D MC dose calculation (4DMC{sub recal}) to assess the dosimetric impact of organ deformations. The 4DMC{sub recal} plans were renormalized (4DMC{sub renorm}) to 95 % dose coverage of the PTV{sub 5} {sub mm} for comparisons with the 4DMCO plans. A 3DMCO plan was considered adequate if the 4DMC{sub recal} plan showed ≥ 95 % of the PTV{sub 3} {sub mm} receiving 60 Gy and doses to other organs at risk (OARs) were below the limits. In seven lesions, 3DMCO was inadequate, providing < 95 % dose coverage to the PTV{sub 3} {sub mm}. Comparison of 4DMC{sub recal} and 3DMCO plans showed that organ deformations resulted in lower OAR doses. Renormalizing the 4DMC{sub recal} plans could produce OAR doses higher than the tolerances in some 4DMC{sub renorm} plans. Dose conformity of the 4DMC{sub renorm} plans was inferior to that of the 3DMCO and 4DMCO plans. The 4DMCO plans did not always achieve OAR dose reductions compared to 3DMCO and 4DMC{sub renorm} plans. This study indicates that 3DMCO with 2 mm margins for organ deformations may be inadequate for Cyberknife-based lung stereotactic body radiotherapy (SBRT). Renormalizing the 4DMC{sub recal} plans could produce degraded dose conformity and increased OAR doses; 4DMCO can resolve this problem. (orig.) [German] Untersucht wurde die Angemessenheit einer dreidimensionalen (3-D) Monte

  4. Frameless image-guided neurosurgery in motion

    NARCIS (Netherlands)

    Woerdeman, P.A.

    2008-01-01

    The general objective of this thesis was the enhancement of image-guidance system use by optimizing “man-machine” interaction in frameless image-guided neurosurgery. Part I. The application of frameless stereotaxy in the neurosurgical practice We aimed to compare three patient-to-image registration

  5. Development of a Meso-Scale SMA-Based Torsion Actuator for Image-Guided Procedures.

    Science.gov (United States)

    Sheng, Jun; Gandhi, Dheeraj; Gullapalli, Rao; Simard, J Marc; Desai, Jaydev P

    2017-02-01

    This paper presents the design, modeling, and control of a meso-scale torsion actuator based on shape memory alloy (SMA) for image-guided surgical procedures. Developing a miniature torsion actuator is challenging, but it opens the possibility of significantly enhancing the robot agility and maneuverability. The proposed torsion actuator is bi-directionally actuated by a pair of antagonistic SMA torsion springs through alternate Joule heating and natural cooling. The torsion actuator is integrated into a surgical robot prototype to demonstrate its working performance in the humid environment under C-Arm CT image guidance.

  6. Toward integrated image guided liver surgery

    Science.gov (United States)

    Jarnagin, W. R.; Simpson, Amber L.; Miga, M. I.

    2017-03-01

    While clinical neurosurgery has benefited from the advent of frameless image guidance for over three decades, the translation of image guided technologies to abdominal surgery, and more specifically liver resection, has been far more limited. Fundamentally, the workflow, complexity, and presentation have confounded development. With the first real efforts in translation beginning at the turn of the millennia, the work in developing novel augmented technologies to enhance screening, planning, and surgery has come to realization for the field. In this paper, we will review several examples from our own work that demonstrate the impact of image-guided procedure methods in eight clinical studies that speak to: (1) the accuracy in planning for liver resection, (2) enhanced surgical planning with portal vein embolization impact, (3) linking splenic volume changes to post-hepatectomy complications, (4) enhanced intraoperative localization in surgically occult lesions, (5) validation of deformation correction, and a (6) a novel blinded study focused at the value of deformation correction. All six of these studies were achieved in human systems and show the potential impact image guided methodologies could make on liver tissue resection procedures.

  7. Image fusion and navigation platforms for percutaneous image-guided interventions.

    Science.gov (United States)

    Rajagopal, Manoj; Venkatesan, Aradhana M

    2016-04-01

    Image-guided interventional procedures, particularly image guided biopsy and ablation, serve an important role in the care of the oncology patient. The need for tumor genomic and proteomic profiling, early tumor response assessment and confirmation of early recurrence are common scenarios that may necessitate successful biopsies of targets, including those that are small, anatomically unfavorable or inconspicuous. As image-guided ablation is increasingly incorporated into interventional oncology practice, similar obstacles are posed for the ablation of technically challenging tumor targets. Navigation tools, including image fusion and device tracking, can enable abdominal interventionalists to more accurately target challenging biopsy and ablation targets. Image fusion technologies enable multimodality fusion and real-time co-displays of US, CT, MRI, and PET/CT data, with navigational technologies including electromagnetic tracking, robotic, cone beam CT, optical, and laser guidance of interventional devices. Image fusion and navigational platform technology is reviewed in this article, including the results of studies implementing their use for interventional procedures. Pre-clinical and clinical experiences to date suggest these technologies have the potential to reduce procedure risk, time, and radiation dose to both the patient and the operator, with a valuable role to play for complex image-guided interventions.

  8. [Robotics].

    Science.gov (United States)

    Bier, J

    2000-05-01

    Content of this paper is the current state of the art of robots in surgery and the ongoing work on the field of surgical robotics at the Clinic for Maxillofacial Surgery at the Charité. Robots in surgery allows the surgeon to transform the accuracy of the imaging systems directly during the intervention and to plan an intervention beforehand. In this paper firstly the state of the art is described. Subsequently the scientific work at the clinic is described in detail. The paper closes with a outlook for future applications of robotics systems in maxillofacial surgery.

  9. Image-guided drug delivery: preclinical applications and clinical translation

    NARCIS (Netherlands)

    Ojha, Tarun; Rizzo, Larissa; Storm, Gert; Kiessling, Fabian; Lammers, Twan

    2015-01-01

    Image-guided drug delivery refers to the combination of drug targeting and imaging. Preclinically, image-guided drug delivery can be used for several different purposes, including for monitoring biodistribution, target site accumulation, off-target localization, drug release and drug efficacy. Clini

  10. Image-guided drug delivery : Preclinical applications and clinical translation

    NARCIS (Netherlands)

    Ojha, Tarun; Rizzo, Larissa; Storm, G; Kiessling, Fabian; Lammers, Twan

    2015-01-01

    Image-guided drug delivery refers to the combination of drug targeting and imaging. Preclinically, image-guided drug delivery can be used for several different purposes, including for monitoring biodistribution, target site accumulation, off-target localization, drug release and drug efficacy. Clini

  11. Stereotactic (Mammographically Guided) Breast Biopsy

    Science.gov (United States)

    ... Resources Professions Site Index A-Z Stereotactic Breast Biopsy Stereotactic breast biopsy uses mammography – a specific type ... Breast Biopsy? What is Stereotactic (Mammographically Guided) Breast Biopsy? Lumps or abnormalities in the breast are often ...

  12. UROLOGIC ROBOTS AND FUTURE DIRECTIONS

    Science.gov (United States)

    Mozer, Pierre; Troccaz, Jocelyne; Stoianovici, Dan

    2009-01-01

    Purpose of review Robot-assisted laparoscopic surgery in urology has gained immense popularity with the Da Vinci system but a lot of research teams are working on new robots. The purpose of this paper is to review current urologic robots and present future developments directions. Recent findings Future systems are expected to advance in two directions: improvements of remote manipulation robots and developments of image-guided robots. Summary The final goal of robots is to allow safer and more homogeneous outcomes with less variability of surgeon performance, as well as new tools to perform tasks based on medical transcutaneous imaging, in a less invasive way, at lower costs. It is expected that improvements for remote system could be augmented reality, haptic feed back, size reduction and development of new tools for NOTES surgery. The paradigm of image-guided robots is close to a clinical availability and the most advanced robots are presented with end-user technical assessments. It is also notable that the potential of robots lies much further ahead than the accomplishments of the daVinci system. The integration of imaging with robotics holds a substantial promise, because this can accomplish tasks otherwise impossible. Image guided robots have the potential to offer a paradigm shift. PMID:19057227

  13. Stereotactic Radiosurgery and Stereotactic Body Radiotherapy (SBRT)

    Science.gov (United States)

    ... is the procedure performed? • Stereotactic Radiosurgery Using the Gamma Knife Gamma Knife radiosurgery involves four phases: placement of the head ... also a guiding device that makes sure the Gamma Knife beams are focused exactly where the treatment is ...

  14. The concept of image-guided therapy.

    Science.gov (United States)

    Vosburgh, Kirby G; Jolesz, Ferenc A

    2003-02-01

    Parallel with current applications in minimally invasive surgery, the introduction of new imaging modalities, and the availability of high-performance computing, new image-guided therapies are being developed at an impressive rate. Indeed, across a broad front of imaging technologies, rapid advances are being realized. Vastly refined technology for processing and using images, as well as improved therapeutic end-effectors, have no doubt hastened this remarkable progress. At the same time, advances in clinical evaluation and complementary technologies will provide the necessary infrastructure through which IGT can be applied in diverse therapeutic settings--from the already well-established neurosurgical applications to the thermal ablation of tumors in organs other than the brain. That IGT is more efficient and effective and less expensive than conventional surgery has been confirmed both in extensive, long-term studies and in ongoing, revolutionary applications in the operating room. We have laid critical groundwork with this extraordinary technology and have now begun to realize quantifiable benefits in terms of improved surgical and patient outcomes.

  15. Resection of deep-seated gliomas using neuroimaging for stereotactic placement of guidance catheters

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Kengo; Higashi, Hisato; Tomita, Susumu; Furuta, Tomohisa; Ohmoto, Takashi [Okayama Univ. (Japan). School of Medicine

    1995-03-01

    A simple computed tomography- (CT) or magnetic resonance (MR) imaging-guided stereotactic method for guided microsurgical resection of either deep-seated gliomas or tumors adjacent to an eloquent area is described. The technique employs the Brown-Roberts-Wells stereotactic system and twist drills, 2.7 mm in diameter, for the stereotactic placement of 2.4 mm diameter scaled guidance catheters through the calvaria. In a patient with a deep-seated small glioma, less than 2 cm diameter, one catheter was implanted into the center of the enhanced mass through the cerebral cortex. In the other 14 patients, three to six catheters were used which made the tumor border clearer. After implantation of the guidance catheters, the stereotactic frame was removed and a standard open craniotomy performed. Target localization is not affected by brain movement, which is inevitable during open surgery. The tumor involved the frontal lobe in eight patients, the parietal lobe in two, and the thalamus in five. In all cases the lesion was quickly localized and radical removal was acheived. Neurological complications occurred in only one patient who suffered transient hemiparesis after the resection of a lesion in the pyramidal tract. The results demonstrate that microsurgery combined with CT- or MR imaging-guided stereotactic placement of guidance catheters is a new option for surgery of deep-seated gliomas or tumors adjacent to an eloquent area. (author).

  16. Nanomedicines for image-guided cancer therapy (Conference Presentation)

    Science.gov (United States)

    Zheng, Jinzi

    2016-09-01

    Imaging technologies are being increasingly employed to guide the delivery of cancer therapies with the intent to increase their performance and efficacy. To date, many patients have benefited from image-guided treatments through prolonged survival and improvements in quality of life. Advances in nanomedicine have enabled the development of multifunctional imaging agents that can further increase the performance of image-guided cancer therapy. Specifically, this talk will focus on examples that demonstrate the benefits and application of nanomedicine in the context of image-guide surgery, personalized drug delivery, tracking of cell therapies and high precision radiotherapy delivery.

  17. Robots

    Institute of Scientific and Technical Information of China (English)

    驷萍

    1997-01-01

    一篇介绍机器人的文章写得如此耐读,如此清新! 首先.我们弄清了robot一词的来历: It was used first in 1920 in a play by Czcchoslovak writer Karel Capek.The wordrobot comes from the Czech word for slave. 上句提供了一个时间:1920。文章接着便抓住这个时间做文章: 且The word robot.and robots themselves are less than 100 years old.But humanshave been dreaming of real and imaginary copies of themselves for thousands of years. 文章就这样写出了波澜,1920年和 thousands of years自然而然构成了强烈对比。1954年和1960s是两个谈及机器人时不得不一提的时间: In 1954,the world’s first robot was produced in the United States. During the 1960s,the first industrial robots appeared beside human workers infactories.下面这句让我们体味到 the Czech word for slave中的 slave不仅言之有理,而且影视和小说里的机器人“造反”,进而 killed the humans who made them的情节也“事出有因”: What do today’s robots do?Robots do work.Work that human consideruninteresting or dangerous.…do many jobs that people consider tiring. 本文将机器人的“功过”放在一起写,笔

  18. Extracranial image-guided stereotactic; Stereotaxie extracranienne guidee par l'image

    Energy Technology Data Exchange (ETDEWEB)

    Ailleres, N.; Fenoglietto, P.; Boisselier, P.; Santoro, L.; Idri, K.; Simeon, S.; Azria, D.; Dubois, J.B. [CRLCC, Val d' Aurelle-Paul-Lamarque, Dept. de Radiotherapie Oncologique, 34 - Montpellier (France)

    2009-10-15

    The use of three-dimensional imaging board associated to dynamic computed tomography allows to reduce the patients positioning margins and to make sure that the target stays in the planned treatment volume (P.T.V.) during the different sessions. (N.C.)

  19. Stereotactic Image-Guided Navigation During Breast Reconstruction in Patients With Breast Cancer

    Science.gov (United States)

    2017-04-12

    Ductal Breast Carcinoma in Situ; Lobular Breast Carcinoma in Situ; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer

  20. Image-guided radiation therapy. Paradigm change in radiation therapy; Bildgestuetzte Strahlentherapie. Paradigmenwechsel in der Strahlentherapie

    Energy Technology Data Exchange (ETDEWEB)

    Wenz, F. [Universitaetsmedizin Mannheim der Universitaet Heidelberg, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany); Belka, C. [Klinikum der Ludwig-Maximilians-Universitaet, Klinik fuer Strahlentherapie und Radioonkologie, Muenchen (Germany); Reiser, M. [Klinikum der Ludwig-Maximilians-Universitaet, Institut fuer Klinische Radiologie, Muenchen (Germany); Schoenberg, S.O. [Universitaetsmedizin Mannheim der Universitaet Heidelberg, Institut fuer Klinische Radiologie und Nuklearmedizin, Mannheim (Germany)

    2012-03-15

    The introduction of image-guided radiotherapy (IGRT) has changed the workflow in radiation oncology more dramatically than any other innovation in the last decades. Imaging for treatment planning before the initiation of the radiotherapy series does not take alterations in patient anatomy and organ movement into account. The principle of IGRT is the temporal and spatial connection of imaging in the treatment position immediately before radiation treatment. The actual position and the target position are compared using cone-beam computed tomography (CT) or stereotactic ultrasound. The IGRT procedure allows a reduction of the safety margins and dose to normal tissue without an increase in risk of local recurrence. In the future the linear treatment chain in radiation oncology will be developed based on the closed-loop feedback principle. The IGRT procedure is increasingly being used especially for high precision radiotherapy, e.g. for prostate or brain tumors. (orig.) [German] Die Einfuehrung der bildgestuetzten Radiotherapie (IGRT - ''image-guided radiotherapy'') hat wie kaum eine andere Innovation die Behandlungsablaeufe in der Radioonkologie veraendert. Eine einmalige Bildgebung zur Bestrahlungsplanung vor der Behandlungsserie beruecksichtigt nicht die Aenderung der Patientengeometrie und die Organbeweglichkeit. Das Prinzip der IGRT besteht in der raeumlichen und zeitlichen Zusammenfuehrung von Bildgebung in der Bestrahlungsposition unmittelbar vor der eigentlichen Bestrahlung. Mittels Cone-beam-CT oder stereotaktischem Ultraschall wird die Ist- mit der Sollposition verglichen. Die IGRT erlaubt die Reduktion der Sicherheitssaeume und damit die Schonung des Normalgewebes, ohne das Rezidivrisiko zu erhoehen. Zukuenftig wird die lineare Behandlungskette in der Radioonkologie durch eine geschlossene, multipel rueckgekoppelte Therapieschleife ersetzt werden. Speziell bei Praezisionsbestrahlungen wie z. B. Prostata- oder Hirntumoren kommt die IGRT

  1. Spine Stereotactic Body Radiotherapy Utilizing Cone-Beam CT Image-Guidance With a Robotic Couch: Intrafraction Motion Analysis Accounting for all Six Degrees of Freedom

    Energy Technology Data Exchange (ETDEWEB)

    Hyde, Derek [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario (Canada); British Columbia Cancer Agency, The Sindi Hawkins Cancer Centre for the Southern Interior, Kelowna (Canada); Lochray, Fiona; Korol, Renee; Davidson, Melanie; Wong, C. Shun [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario (Canada); Ma, Lijun [Department of Radiation Oncology, University of California San Francisco, San Francisco, CA (United States); Sahgal, Arjun, E-mail: Arjun.sahgal@rmp.uhn.on.ca [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto (Canada)

    2012-03-01

    Purpose: To evaluate the residual setup error and intrafraction motion following kilovoltage cone-beam CT (CBCT) image guidance, for immobilized spine stereotactic body radiotherapy (SBRT) patients, with positioning corrected for in all six degrees of freedom. Methods and Materials: Analysis is based on 42 consecutive patients (48 thoracic and/or lumbar metastases) treated with a total of 106 fractions and 307 image registrations. Following initial setup, a CBCT was acquired for patient alignment and a pretreatment CBCT taken to verify shifts and determine the residual setup error, followed by a midtreatment and posttreatment CBCT image. For 13 single-fraction SBRT patients, two midtreatment CBCT images were obtained. Initially, a 1.5-mm and 1 Degree-Sign tolerance was used to reposition the patient following couch shifts which was subsequently reduced to 1 mm and 1 Degree-Sign degree after the first 10 patients. Results: Small positioning errors after the initial CBCT setup were observed, with 90% occurring within 1 mm and 97% within 1 Degree-Sign . In analyzing the impact of the time interval for verification imaging (10 {+-} 3 min) and subsequent image acquisitions (17 {+-} 4 min), the residual setup error was not significantly different (p > 0.05). A significant difference (p = 0.04) in the average three-dimensional intrafraction positional deviations favoring a more strict tolerance in translation (1 mm vs. 1.5 mm) was observed. The absolute intrafraction motion averaged over all patients and all directions along x, y, and z axis ({+-} SD) were 0.7 {+-} 0.5 mm and 0.5 {+-} 0.4 mm for the 1.5 mm and 1 mm tolerance, respectively. Based on a 1-mm and 1 Degree-Sign correction threshold, the target was localized to within 1.2 mm and 0.9 Degree-Sign with 95% confidence. Conclusion: Near-rigid body immobilization, intrafraction CBCT imaging approximately every 15-20 min, and strict repositioning thresholds in six degrees of freedom yields minimal intrafraction motion

  2. Five Fraction Image-Guided Radiosurgery for Primary and Recurrent Meningiomas

    Directory of Open Access Journals (Sweden)

    Eric Karl Oermann

    2013-08-01

    Full Text Available Purpose: Benign tumors that arise from the meninges can be difficult to treat due to their potentially large size and proximity to critical structures such as cranial nerves and sinuses. Single fraction radiosurgery may increase the risk of symptomatic peritumoral edema. In this study, we report our results on the efficacy and safety of five fraction image-guided radiosurgery for benign meningiomas. Materials/Methods: Clinical and radiographic data from 38 patients treated with five fraction radiosurgery were reviewed retrospectively. Mean tumor volume was 3.83mm3 (range, 1.08-20.79 mm3. Radiation was delivered using the CyberKnife, a frameless robotic image-guided radiosurgery system with a median total dose of 25 Gy (range, 25 Gy-35 Gy. Results: The median follow-up was 20 months. Acute toxicity was minimal with eight patients (21% requiring a short course of steroids for headache at the end of treatment. Pre-treatment neurological symptoms were present in 24 patients (63.2%. Post treatment, neurological symptoms resolved completely in 14 patients (58.3%, and were persistent in eight patients (33.3%. There were no local failures, 24 tumors remained stable (64% and 14 regressed (36%. Pre-treatment peritumoral edema was observed in five patients (13.2%. Post-treatment asymptomatic peritumoral edema developed in five additional patients (13.2%. On multivariate analysis, pre-treatment peritumoral edema and location adjacent to a large vein were significant risk factors for radiographic post-treatment edema (p = 0.001 and p = 0.026 respectively. Conclusions: These results suggest that five fraction image-guided radiosurgery is well tolerated with a response rate for neurologic symptoms that is similar to other standard treatment options. Rates of peritumoral edema and new cranial nerve deficits following five fraction radiosurgery were low. Longer follow-up is required to validate the safety and long-term effectiveness of this treatment approach.

  3. Image-guided urological interventions: What the urologists must know

    Directory of Open Access Journals (Sweden)

    Chandan J Das

    2015-01-01

    Full Text Available Advances in imaging technology, especially in the last two decades, have led to a paradigm shift in the field of image-guided interventions in urology. While the traditional biopsy and drainage techniques are firmly established, image-based stone management and endovascular management of hematuria have evolved further. Ablative techniques for renal and prostate cancer and prostate artery embolization for benign prostatic hypertrophy have evolved into viable alternative treatments. Many urologic diseases that were earlier treated surgically are now effectively managed using minimally invasive image-guided techniques, often on a day care basis using only local anesthesia or conscious sedation. This article presents an overview of the technique and status of various image-guided urological procedures, including recent emerging techniques.

  4. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

    Directory of Open Access Journals (Sweden)

    Terrence T. Kim

    2016-01-01

    Full Text Available We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy.

  5. Image-guided therapy: evolution and breakthrough.

    Science.gov (United States)

    Haigron, Pascal; Dillenseger, Jean-Louis; Luo, Limin; Coatrieux, Jean-Louis

    2010-01-01

    Beyond the advances made in computer-assisted interventions and robotic systems, the demand for more efficient and safer therapies remains challenging. Thus, if it is possible to improve the instrument tracking, steering, and target localization, to miniaturize the sensors and actuators, and to conduct preoperatively planned minimally invasive therapies, we still need new resources to achieve permanent destruction of abnormal tissues or suppression of pathological processes. Most of the physics-based (or energy-based) therapeutic principles at our disposal have been established a long time ago, but their actions on basic cellular and molecular mechanisms are not yet fully understood. They all have a wide spectrum of clinical targets in terms of organs and pathologies, modes of application (external, interstitial, intraluminal, etc.) with advantages and side-effect drawbacks, proven indications, and contraindications. Some of them may still face controversies regarding their outcomes. This short article, mainly focused on tumor destruction, briefly reviews in its first part some of these techniques and sketches the next generation under investigation. The former include radio frequency (RF), high-intensity focused ultrasound (HiFU), microwaves, and cryotherapy, of which all are temperature based. Laser-based approaches [e.g., photodynamic therapy (PDT) at large] are also discussed. Radiotherapy and its variants (hadrontherapy, brachytherapy, Gamma Knife, and CyberKnife) remain, of course, as the reference technique in cancer treatment. The next breakthroughs are examined in the second part of the article. They are based on the close association between imaging agents, drugs, and some stimulation techniques. The ongoing research efforts in that direction show that, if they are still far from clinical applications, strong expectations are made. From the point of view of interventional planning and image guidance, all of them share a lot of concerns.

  6. [Practical method for six-dimensional online correction system with image guided radiation therapy].

    Science.gov (United States)

    Nakaguchi, Yuji; Araki, Fujio; Kouno, Tomohiro; Maruyama, Masato

    2012-01-01

    In this study, we developed a correction method for coordinate transformation errors that are produced in combination with the ExacTrac X-ray system (BrainLAB) and HexaPOD (Elekta) in image guided radiation therapy (IGRT). The positional accuracy of the correction method was compared between the ExacTrac Robotics (BrainLAB) and no correction. We tried to correct iBeam evo couch top (Elekta) by operating two steps drive like ExacTrac Robotics. No correction for HexaPOD showed a maximal error of 4.52 mm, and the couch did not move to the correct position. However, our correction method for HexaPOD showed the positional accuracy within 1 mm. Our method has no significant difference with ExacTrac Robotics (paired t-test, P>0.1). But, when the correction values for the rotatory directions were large, the positional accuracy tended to be poor. The smallest setup errors for the rotatory directions are important for IGRT.

  7. Fully automated image-guided needle insertion: application to small animal biopsies.

    Science.gov (United States)

    Ayadi, A; Bour, G; Aprahamian, M; Bayle, B; Graebling, P; Gangloff, J; Soler, L; Egly, J M; Marescaux, J

    2007-01-01

    The study of biological process evolution in small animals requires time-consuming and expansive analyses of a large population of animals. Serial analyses of the same animal is potentially a great alternative. However non-invasive procedures must be set up, to retrieve valuable tissue samples from precisely defined areas in living animals. Taking advantage of the high resolution level of in vivo molecular imaging, we defined a procedure to perform image-guided needle insertion and automated biopsy using a micro CT-scan, a robot and a vision system. Workspace limitations in the scanner require the animal to be removed and laid in front of the robot. A vision system composed of a grid projector and a camera is used to register the designed animal-bed with to respect to the robot and to calibrate automatically the needle position and orientation. Automated biopsy is then synchronised with respiration and performed with a pneumatic translation device, at high velocity, to minimize organ deformation. We have experimentally tested our biopsy system with different needles.

  8. Robotics for surgery.

    Science.gov (United States)

    Howe, R D; Matsuoka, Y

    1999-01-01

    Robotic technology is enhancing surgery through improved precision, stability, and dexterity. In image-guided procedures, robots use magnetic resonance and computed tomography image data to guide instruments to the treatment site. This requires new algorithms and user interfaces for planning procedures; it also requires sensors for registering the patient's anatomy with the preoperative image data. Minimally invasive procedures use remotely controlled robots that allow the surgeon to work inside the patient's body without making large incisions. Specialized mechanical designs and sensing technologies are needed to maximize dexterity under these access constraints. Robots have applications in many surgical specialties. In neurosurgery, image-guided robots can biopsy brain lesions with minimal damage to adjacent tissue. In orthopedic surgery, robots are routinely used to shape the femur to precisely fit prosthetic hip joint replacements. Robotic systems are also under development for closed-chest heart bypass, for microsurgical procedures in ophthalmology, and for surgical training and simulation. Although results from initial clinical experience is positive, issues of clinician acceptance, high capital costs, performance validation, and safety remain to be addressed.

  9. Robotics

    Science.gov (United States)

    Rothschild, Lynn J.

    2012-01-01

    Earth's upper atmosphere is an extreme environment: dry, cold, and irradiated. It is unknown whether our aerobiosphere is limited to the transport of life, or there exist organisms that grow and reproduce while airborne (aerophiles); the microenvironments of suspended particles may harbor life at otherwise uninhabited altitudes[2]. The existence of aerophiles would significantly expand the range of planets considered candidates for life by, for example, including the cooler clouds of a hot Venus-like planet. The X project is an effort to engineer a robotic exploration and biosampling payload for a comprehensive survey of Earth's aerobiology. While many one-shot samples have been retrieved from above 15 km, their results are primarily qualitative; variations in method confound comparisons, leaving such major gaps in our knowledge of aerobiology as quantification of populations at different strata and relative species counts[1]. These challenges and X's preliminary solutions are explicated below. X's primary balloon payload is undergoing a series of calibrations before beginning flights in Spring 2012. A suborbital launch is currently planned for Summer 2012. A series of ground samples taken in Winter 2011 is being used to establish baseline counts and identify likely background contaminants.

  10. Imaging guided differentiation of parotid tumors; Bildgebende Differenzierung von Parotistumoren

    Energy Technology Data Exchange (ETDEWEB)

    Kloth, C.; Horger, M.; Haap, M.; Ioanoviciu, S.D.; Boesmueller, H.

    2015-09-15

    Imaging guided differentiation of parotid tumors is helping diagnosis and therapy decision making. It is necessary to consider seldom tumor forms and their characteristic appearance. Modern techniques as diffusion supported NMR imaging sequences and correlated contrast agent kinetics may be helpful besides computer tomography and PET techniques.

  11. Biomedical nanomaterials for imaging-guided cancer therapy

    Science.gov (United States)

    Huang, Yuran; He, Sha; Cao, Weipeng; Cai, Kaiyong; Liang, Xing-Jie

    2012-09-01

    To date, even though various kinds of nanomaterials have been evaluated over the years in order to develop effective cancer therapy, there is still significant challenges in the improvement of the capabilities of nano-carriers. Developing a new theranostic nanomedicine platform for imaging-guided, visualized cancer therapy is currently a promising way to enhance therapeutic efficiency and reduce side effects. Firstly, conventional imaging technologies are reviewed with their advantages and disadvantages, respectively. Then, advanced biomedical materials for multimodal imaging are illustrated in detail, including representative examples for various dual-modalities and triple-modalities. Besides conventional cancer treatment (chemotherapy, radiotherapy), current biomaterials are also summarized for novel cancer therapy based on hyperthermia, photothermal, photodynamic effects, and clinical imaging-guided surgery. In conclusion, biomedical materials for imaging-guided therapy are becoming one of the mainstream treatments for cancer in the future. It is hoped that this review might provide new impetus to understand nanotechnology and nanomaterials employed for imaging-guided cancer therapy.

  12. Image-guided endoscopic transnasal removal of recurrent pituitary adenomas.

    Science.gov (United States)

    Lasio, Giovanni; Ferroli, Paolo; Felisati, Giovanni; Broggi, Giovanni

    2002-07-01

    To assess the role that neuronavigation plays in assisting endoscopic transsphenoidal reoperations for recurrent pituitary adenomas. During a 45-month period, 19 endoscopic endonasal transsphenoidal reoperations were performed for recurrent pituitary adenomas. In 11 of 19 patients, the procedure was performed with the aid of an optically guided system. Clinical records were reviewed retrospectively, with attention to the following: comparison of baseline clinical data, the duration of surgery, and the postoperative course and complications of both image-guided and non-image-guided endoscopic reoperations. In addition, to test the reliability of the neuronavigation system, we made measurements of intraoperative accuracy in five additional transnasal endoscopic procedures in "virgin" noses and sphenoidal sinuses. In both groups studied, we found no difference with regard to either morbidity or mortality, which were null. The mean setup time was 13 minutes shorter in non-image-guided procedures (P = 0.021), and the operative time was 36 minutes shorter in image-guided procedures (P = 0.038). No other statistically significant differences were found between the two groups. In all cases, we found that the system performed without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of the intraoperative accuracy in the axial, coronal, and sagittal planes indicated a mean intraoperatively verified system error of 1.6 +/- 0.6 mm. Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and probably safer.

  13. [Stereotactic radiation therapy].

    Science.gov (United States)

    Aristu, J J; Ciérvide, R; Guridi, J; Moreno, M; Arbea, L; Azcona, J D; Ramos, L I; Zubieta, J L

    2009-01-01

    Stereotactic radiotherapy is a form of external radiotherapy that employs a system of three dimensional coordinates independent of the patient for the precise localisation of the lesion. It also has the characteristic that the radiation beams are conformed and precise, and converge on the lesion, making it possible to administer very high doses of radiotherapy without increasing the radiation to healthy adjacent organs or structures. When the procedure is carried out in one treatment session it is termed radiosurgery, and when administered over several sessions it is termed stereotactic radiotherapy. Special systems of fixing or immobilising the patient (guides or stereotactic frames) are required together with radiotherapy devices capable of generating conformed beams (lineal accelerator, gammaknife, cyberknife, tomotherapy, cyclotrons). Modern stereotactic radiotherapy employs intra-tumoural radio-opaque frames or CAT image systems included in the irradiation device, which make possible a precise localisation of mobile lesions in each treatment session. Besides, technological advances make it possible to coordinate the lesion's movements in breathing with the radiotherapy unit (gating and tracking) for maximum tightening of margins and excluding a greater volume of healthy tissue. Radiosurgery is mainly indicated in benign or malign cerebral lesions less than 3-4 centimetres (arteriovenous malformations, neurinomas, meningiomas, cerebral metastases) and stereotactic radiotherapy is basically administered in tumours of extracraneal localisation that require high conforming and precision, such as inoperable early lung cancer and hepatic metastasis.

  14. Dosimetric comparison of MRI-based HDR brachytherapy and stereotactic radiotherapy in patients with advanced cervical cancer: A virtual brachytherapy study

    Science.gov (United States)

    Otahal, Bretislav; Dolezel, Martin; Cvek, Jakub; Simetka, Ondrej; Klat, Jaroslav; Knybel, Lukas; Molenda, Lukas; Skacelikova, Eva; Hlavka, Ales; Feltl, David

    2014-01-01

    Aim To evaluate the treatment plans of 3D image-guided brachytherapy (BT) and stereotactic robotic radiotherapy with online image guidance – CyberKnife (CK) in patients with locally advanced cervix cancer. Methods and materials Ten pairs of plans for patients with locally advanced inoperable cervical cancer were created using MR based 3D brachytherapy and stereotaxis CK. The dose that covers 98% of the target volume (HR CTV D98) was taken as a reference and other parameters were compared. Results Of the ten studied cases, the dose from D100 GTV was comparable for both devices, on average, the BT GTV D90 was 10–20% higher than for CK. The HR CTV D90 was higher for CK with an average difference of 10–20%, but only fifteen percent of HR CTV (the peripheral part) received a higher dose from CK, while 85% of the target volume received higher doses from BT. We found a significant organ-sparing effect of CK compared to brachytherapy (20–30% lower doses in 0.1 cm3, 1 cm3, and 2 cm3). Conclusion BT remains to be the best method for dose escalation. Due to the significant organ-sparing effect of CK, patients that are not candidates for BT could benefit from stereotaxis more than from classical external beam radiotherapy. PMID:25337413

  15. Challenges and opportunities in image guided particle therapy.

    Science.gov (United States)

    Riboldi, M; Baroni, G

    2015-01-01

    The application of biomedical imaging and image processing to radiation therapy with accelerated particles has unique challenges. The potential of particle therapy to precisely tailor the dose distribution around the target volume needs to account for the intrinsic sensitivity to uncertainties in dose deposition. These peculiar features motivate the use of image guided methods to consistently verify the accuracy in dose delivery. Dedicated imaging and image processing methods are required, from treatment planning to treatment verification phases, in order to reduce the effects of uncertainties. The scenario is also complicated by the lack of standardized layouts of treatment bunkers, which implies the relatively increased use of custom solutions. Conversely, imaging can be applied to verify the actual delivered dose, representing a valuable opportunity to validate specific protocols and visualize the efficacy of the intended treatment. In this contribution, challenges and opportunities in image guided particle therapy are overviewed, with a clear focus on research perspectives in biomedical imaging and image processing.

  16. Multifunctional ultrasound contrast agents for imaging guided photothermal therapy.

    Science.gov (United States)

    Guo, Caixin; Jin, Yushen; Dai, Zhifei

    2014-05-21

    Among all the imaging techniques, ultrasound imaging has a unique advantage due to its features of real-time, low cost, high safety, and portability. Ultrasound contrast agents (UCAs) have been widely used to enhance ultrasonic signals. One of the most exciting features of UCAs for use in biomedicine is the possibility of easily putting new combinations of functional molecules into microbubbles (MBs), which are the most routinely used UCAs. Various therapeutic agents and medical nanoparticles (quantum dots, gold, Fe3O4, etc.) can be loaded into ultrasound-responsive MBs. Hence, UCAs can be developed as multifunctional agents that integrate capabilities for early detection and diagnosis and for imaging guided therapy of various diseases. The current review will focus on such state-of-the-art UCA platforms that have been exploited for multimodal imaging and for imaging guided photothermal therapy.

  17. IMAGE-GUIDED RADIOTHERAPY AND -BRACHYTHERAPY FOR CERVICAL CANCER

    Directory of Open Access Journals (Sweden)

    Suresh eDutta

    2015-03-01

    Full Text Available Conventional radiotherapy for cervical cancer relies on clinical examination, 3-dimensional conformal radiotherapy (3D-CRT, and 2-dimensional intracavitary brachytherapy.Excellent local control and survival have been obtained for small early stage cervical cancer with definitive radiotherapy. For bulky and locally advanced disease, the addition of chemotherapy has improved the prognosis but toxicity remains significant. New imaging technology such as positron emission tomography (PET and magnetic resonance imaging (MRI has improved tumor delineation for radiotherapy planning. Image-guided radiotherapy (IGRT may decrease treatment toxicity of whole pelvic radiation because of its potential for bone marrow, bowel, and bladder sparring. Tumor shrinkage during whole pelvic IGRT may optimize image-guided brachytherapy (IGBT, allowing for better local control and reduced toxicity for patients with cervical cancer. IGRT and IGBT should be integrated in future prospective studies for cervical cancer.

  18. Assessing image-guided implant surgery in today's clinical practice.

    Science.gov (United States)

    Norkin, Frederic J; Ganeles, Jeffrey; Zfaz, Samuel; Modares, Alireza

    2013-01-01

    As implant dentistry has progressed, greater emphasis has been placed on natural-looking tooth replacement, minimally invasive techniques, and better cost efficiencies, with implant positioning being guided by the desired prosthetic outcome. Image-guided surgery is a technique that merges preoperative diagnostic imaging with computer-based planning tools to facilitate surgical and restorative plans and procedures. This article discusses the intricacies of guided implant surgery, including 3-dimensional presurgical planning and the challenges of maintaining guide stability during surgical execution.

  19. Image Guided Biodistribution of Drugs and Drug Delivery

    OpenAIRE

    Ding, Hong; Wu, Fang

    2012-01-01

    Image guided technique is playing an increasingly important role in the investigation of the biodistribution and pharmacokinetics of drugs or drug delivery systems. The application of these new materials and techniques with combined properties of diagnosis and therapy can benefit the development of targeted drug delivery system and modern personalized medicine This special issue provides an up-to-date collection of original research articles and review on the development of novel targeted dru...

  20. Image-guided drainage of cystic vestibular schwannomata.

    Science.gov (United States)

    Barrett, Chris; Prasad, K S Manjunath; Hill, John; Johnson, Ian; Heaton, Judith M; Crossman, John E; Mendelow, Alexander D

    2010-01-01

    The management of vestibular schwannomata is controversial. Surveillance remains an acceptable option for elderly patients or those with small lesions. Stereoradiosurgery is also an option, while surgery is often preferred in younger patients with larger lesions. In elderly patients with lesions causing brainstem compression, craniotomy is a major undertaking. We report two cases of cystic cerebellopontine angle tumours in patients with co-morbidity, who were managed successfully with image-guided insertion of a cystoperitoneal shunt.

  1. Image-guided resection of cerebral cavernous malformations

    Institute of Scientific and Technical Information of China (English)

    毛颖; 周良辅; 杜固宏; 陈亮

    2003-01-01

    Objective To evaluate retrospectively the effectiveness of image-guided navigation techniques in the management of cerebral CMs.Methods Between July 1997 and January 2001, 44 patients underwent image-guided resection of cerebral CMs. To counteract brain shift, a small silicon catheter was implanted as a guide in the case of deep-seated lesions (except in the case of brain stem CMs) and before excision of multiple lesions. Results A total of 27 men and 17 women with a mean age of 35 years underwent surgical procedures (5 patients had multiple lesions). The lesions were located in the frontal (n=14), lobe temporal lobe (n=12), parietal lobe (n=6), cerebellum (n=6), thalamus (n=5), pons (n=5), and orbital region (n=1). Under the guidance of a StealthStation navigator, total removal of the lesions was achieved in all patients. Follow-up revealed marked improvement of preoperative symptoms in 26 patients and no additional deficits in 13 patients. Five patients suffered from additional neurological deficits, but two of them gradually improved during the follow-up period. Conclusions With the assistance of an image-guided surgical system, functional areas can be effectively avoided and surgical injury can be decreased. This system is well suited for accurate localization and safe resection of small, deep-seated CMs.

  2. Recent advances in different modal imaging-guided photothermal therapy.

    Science.gov (United States)

    Chen, Qiwen; Wen, Jia; Li, Hongjuan; Xu, Yongqian; Liu, Fengyu; Sun, Shiguo

    2016-11-01

    Photothermal therapy (PTT) has recently attracted considerable attention owing to its controllable treatment process, high tumour eradication efficiency and minimal side effects on non-cancer cells. PTT can melt cancerous cells by localising tissue hyperthermia induced by internalised therapeutic agents with a high photothermal conversion efficiency under external laser irradiation. Numerous in vitro and in vivo studies have shown the significant potential of PTT to treat tumours in future practical applications. Unfortunately, the lack of visualisation towards agent delivery and internalisation, as well as imaging-guided comprehensive evaluation of therapeutic outcome, limits its further application. Developments in combined photothermal therapeutic nanoplatforms guided by different imaging modalities have compensated for the major drawback of PTT alone, proving PTT to be a promising technique in biomedical applications. In this review, we introduce recent developments in different imaging modalities including single-modal, dual-modal, triple-modal and even multi-modal imaging-guided PTT, together with imaging-guided multi-functional theranostic nanoplatforms.

  3. Technical note: rapid prototyping of 3D grid arrays for image guided therapy quality assurance.

    Science.gov (United States)

    Kittle, David; Holshouser, Barbara; Slater, James M; Guenther, Bob D; Pitsianis, Nikos P; Pearlstein, Robert D

    2008-12-01

    Three dimensional grid phantoms offer a number of advantages for measuring imaging related spatial inaccuracies for image guided surgery and radiotherapy. The authors examined the use of rapid prototyping technology for directly fabricating 3D grid phantoms from CAD drawings. We tested three different fabrication process materials, photopolymer jet with acrylic resin (PJ/AR), selective laser sintering with polyamide (SLS/P), and fused deposition modeling with acrylonitrile butadiene styrene (FDM/ABS). The test objects consisted of rectangular arrays of control points formed by the intersections of posts and struts (2 mm rectangular cross section) and spaced 8 mm apart in the x, y, and z directions. The PJ/AR phantom expanded after immersion in water which resulted in permanent warping of the structure. The surface of the FDM/ABS grid exhibited a regular pattern of depressions and ridges from the extrusion process. SLS/P showed the best combination of build accuracy, surface finish, and stability. Based on these findings, a grid phantom for assessing machine-dependent and frame-induced MR spatial distortions was fabricated to be used for quality assurance in stereotactic neurosurgical and radiotherapy procedures. The spatial uniformity of the SLS/P grid control point array was determined by CT imaging (0.6 x 0.6 x 0.625 mm3 resolution) and found suitable for the application, with over 97.5% of the control points located within 0.3 mm of the position specified in CAD drawing and none of the points off by more than 0.4 mm. Rapid prototyping is a flexible and cost effective alternative for development of customized grid phantoms for medical physics quality assurance.

  4. Urologic robots and future directions

    CERN Document Server

    Mozer, Pierre; Stoianovici, Dan; 10.1097/MOU.0b013e32831cc1ba

    2008-01-01

    PURPOSE OF REVIEW: Robot-assisted laparoscopic surgery in urology has gained immense popularity with the daVinci system, but a lot of research teams are working on new robots. The purpose of this study is to review current urologic robots and present future development directions. RECENT FINDINGS: Future systems are expected to advance in two directions: improvements of remote manipulation robots and developments of image-guided robots. SUMMARY: The final goal of robots is to allow safer and more homogeneous outcomes with less variability of surgeon performance, as well as new tools to perform tasks on the basis of medical transcutaneous imaging, in a less invasive way, at lower costs. It is expected that improvements for a remote system could be augmented in reality, with haptic feedback, size reduction, and development of new tools for natural orifice translumenal endoscopic surgery. The paradigm of image-guided robots is close to clinical availability and the most advanced robots are presented with end-use...

  5. Image-guided percutaneous internal fixation of sacral fracture.

    Science.gov (United States)

    Kinon, Merritt D; Desai, Rupen; Loriaux, Daniel; Houten, John K

    2016-01-01

    Percutaneous iliosacral screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. The use of stereotactic image guidance has been shown to provide superior accuracy in the placement of spinal instrumentation. Here, the authors describe a novel application of O-arm technology (Medtronic Sofamor Danek, Memphis, TN, USA) to help safely place iliosacral screws for the treatment of a traumatic sacral fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Early manifestation of communicating hydrocephalus after fractionated stereotactic radiotherapy for aggressive giant atypical prolactinoma.

    Science.gov (United States)

    Ohtakara, Kazuhiro; Ohe, Naoyuki; Iwama, Toru; Hoshi, Hiroaki

    2014-05-01

    Aggressive giant invasive pituitary adenomas refractory to standard surgical or medical treatment remain a genuine challenge. In addition, communicating hydrocephalus (CH) attributed to malabsorption of cerebrospinal fluid (CSF) developing after radiotherapy for pituitary adenomas has not been previously reported. Herein, we describe the case of a 48-year-old male presenting with a giant atypical prolactinoma refractory to previous therapies, including pharmacotherapy and repetitive surgery. He underwent image-guided fractionated stereotactic radiotherapy in 28 fractions, resulting in early manifestation of CH associated with undisputed, both radiological and hormonal response. He recovered well after a shunt placement, with otherwise favorable consequences such as sustained tumor regression, decreasing prolactin level, and retained visual function for a 22-month follow-up. Fractionated stereotactic radiotherapy would provide a viable treatment alternative for these refractory cases, while caution should be exercised regarding the possibility of iatrogenic CH.

  7. An ultrasound image-guided surgical workflow model

    Science.gov (United States)

    Guo, Bing; Lemke, Heinz; Liu, Brent; Huang, H. K.; Grant, Edward G.

    2006-03-01

    A 2003 report in the Journal of Annual Surgery predicted an increase in demand for surgical services to be as high as 14 to 47% in the workload of all surgical fields by 2020. Medical difficulties which are already now apparent in the surgical OR (Operation Room) will be amplified in the near future and it is necessary to address this problem and develop strategies to handle the workload. Workflow issues are central to the efficiency of the OR and in response to today's continuing workforce shortages and escalating costs. Among them include: Inefficient and redundant processes, System Inflexibility, Ergonomic deficiencies, Scattered Data, Lack of Guidelines, Standards, and Organization. The objective of this research is to validate the hypothesis that a workflow model does improve the efficiency and quality of surgical procedure. We chose to study the image-guided surgical workflow for US as a first proof of concept by minimizing the OR workflow issues. We developed, and implemented deformable workflow models using existing and projected future clinical environment data as well as a customized ICT system with seamless integration and real-time availability. An ultrasound (US) image-guided surgical workflow (IG SWF) for a specific surgical procedure, the US IG Liver Biopsy, was researched to find out the inefficient and redundant processes, scattered data in clinical systems, and improve the overall quality of surgical procedures to the patient.

  8. Image-guided plasma therapy of cutaneous wound

    Science.gov (United States)

    Zhang, Zhiwu; Ren, Wenqi; Yu, Zelin; Zhang, Shiwu; Yue, Ting; Xu, Ronald

    2014-02-01

    The wound healing process involves the reparative phases of inflammation, proliferation, and remodeling. Interrupting any of these phases may result in chronically unhealed wounds, amputation, or even patient death. Despite the clinical significance in chronic wound management, no effective methods have been developed for quantitative image-guided treatment. We integrated a multimodal imaging system with a cold atmospheric plasma probe for image-guided treatment of chronic wound. Multimodal imaging system offers a non-invasive, painless, simultaneous and quantitative assessment of cutaneous wound healing. Cold atmospheric plasma accelerates the wound healing process through many mechanisms including decontamination, coagulation and stimulation of the wound healing. The therapeutic effect of cold atmospheric plasma is studied in vivo under the guidance of a multimodal imaging system. Cutaneous wounds are created on the dorsal skin of the nude mice. During the healing process, the sample wound is treated by cold atmospheric plasma at different controlled dosage, while the control wound is healed naturally. The multimodal imaging system integrating a multispectral imaging module and a laser speckle imaging module is used to collect the information of cutaneous tissue oxygenation (i.e. oxygen saturation, StO2) and blood perfusion simultaneously to assess and guide the plasma therapy. Our preliminary tests show that cold atmospheric plasma in combination with multimodal imaging guidance has the potential to facilitate the healing of chronic wounds.

  9. Fluorescence and image guided resection in high grade glioma.

    Science.gov (United States)

    Panciani, Pier Paolo; Fontanella, Marco; Schatlo, Bawarjan; Garbossa, Diego; Agnoletti, Alessandro; Ducati, Alessandro; Lanotte, Michele

    2012-01-01

    The extent of resection in high grade glioma is increasingly been shown to positively effect survival. Nevertheless, heterogeneity and migratory behavior of glioma cells make gross total resection very challenging. Several techniques were used in order to improve the detection of residual tumor. Aim of this study was to analyze advantages and limitations of fluorescence and image guided resection. A multicentric prospective study was designed to evaluate the accuracy of each method. Furthermore, the role of 5-aminolevulinc acid and neuronavigation were reviewed. Twenty-three patients harboring suspected high grade glioma, amenable to complete resection, were enrolled. Fluorescence and image guides were used to perform surgery. Multiple samples were obtained from the resection cavity of each lesion according to 5-ALA staining positivity and boundaries as delineated by neuronavigation. All samples were analyzed by a pathologist blinded to the intra-operative labeling. Decision-making based on fluorescence showed a sensitivity of 91.1% and a specificity of 89.4% (pimage-guided resection accuracy was low (sensitivity: 57.8%; specificity: 57.4%; p=0.346). We observed that the sensitivity of 5-ALA can be improved by the combined use of neuronavigation, but this leads to a significant reduction in specificity. Thus, the use of auxiliary techniques should always be subject to critical skills of the surgeon. We advocate a large-scale study to further improve the assessment of multimodal approaches.

  10. Robotics and radiosurgery--the cyberknife.

    Science.gov (United States)

    Chang, S D; Adler, J R

    2001-01-01

    The Cyberknife is a dedicated image-guided robotic radiosurgical device. While clinical results with intracranial lesions are comparable to frame-based radiosurgical techniques, recent experience demonstrates the potential to broadly expand the scope of radiosurgery to many extracranial sites.

  11. Virtual Reality Aided Positioning of Mobile C-Arms for Image-Guided Surgery

    Directory of Open Access Journals (Sweden)

    Zhenzhou Shao

    2014-06-01

    Full Text Available For the image-guided surgery, the positioning of mobile C-arms is a key technique to take X-ray images in a desired pose for the confirmation of current surgical outcome. Unfortunately, surgeons and patient often suffer the radiation exposure due to the repeated imaging when the X-ray image is of poor quality or not captured at a good projection view. In this paper, a virtual reality (VR aided positioning method for the mobile C-arm is proposed by the alignment of 3D surface model of region of interest and preoperative anatomy, so that a reference pose of the mobile C-arm with respect to the inside anatomy can be figured out from outside view. It allows a one-time imaging from the outside view to greatly reduce the additional radiation exposure. To control the mobile C-arm to the desired pose, the mobile C-arm is modeled as a robotic arm with a movable base. Experiments were conducted to evaluate the accuracy of appearance model and precision of mobile C-arm positioning. The appearance model was reconstructed with the average error of 2.16 mm. One-time imaging of mobile C-arm was achieved, and new modeling of mobile C-arm with 8 DoFs enlarges the working space in the operating room.

  12. Review of long-term results of stereotactic psychosurgery.

    Science.gov (United States)

    Kim, Moon-Chan; Lee, Tae-Kyu; Choi, Chang-Rak

    2002-09-01

    Stereotactic psychosurgery is an effective method for treating some medically intractable psychiatric illnesses. However, it is unfamiliar and the long-term clinical results have not been reported in Asia. The long-term results of psychosurgery are evaluated and the neuroanatomical basis is discussed. Twenty-one patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses since 1993. All were referred from psychiatrists for these disorders. Two patients showed aggressive behavior, 12 had obsessive-compulsive disorder (OCD), and seven had depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were performed for aggressive behavior, limbic leucotomy was performed for OCD, and subcaudate tractotomy with or without cingulotomy was performed for depression with anxiety. OCD was evaluated with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the visual analogue scale, the Clinical Global Impression Scale, and the Overt Aggression Scale (OAS). The Mini-Mental State Examination and the Wechsler Adult Intelligence Scale-Revised were used for the evaluation of aggressive behavior. The 17-item Hamilton Depression Rating Scale (HAMD) was used for evaluation of depression. Ventriculography was used in the first seven patients and magnetic resonance imaging-guided stereotaxy was used in the recent 14 cases for localization of the target. The lesions were made with a radiofrequency lesion generator. OAS scores in the two patients with aggressive behavior during follow up declined from 8 to 2 with clinical improvement. All 12 patients with OCD returned to their previous life and showed the mean YBOCS scores decreased from 34 to 3. Ten patients with OCD could be followed up (mean 45 months). All patients returned to their previous social life. In seven patients with depression with anxiety, HAMD scores declined from 28.5 to 16.5. There was no operative mortality and no significant morbidity except for one case of mild

  13. Image-guided neurosurgery. Global concept of a surgical tele-assistance using obstacle detection robotics; Neurochirurgie guidee par l'image. Concept global d'une tele-assistance chirurgicale a l'aide d'une robotique d'empechement

    Energy Technology Data Exchange (ETDEWEB)

    Desgeorges, M.; Bellegou, N.; Faillot, Th.; Cordoliani, Y.S.; Dutertre, G.; Blondet, E.; Soultrait, F. de; Boissy, J.M. [Hopital d' Instruction des Armees du Val-de-Grace, 75 - Paris (France)

    2000-12-01

    Surgical tele-assistance significantly increases accuracy of surgical gestures, especially in the case of brain tumor neurosurgery. The robotic device is tele-operated through a microscope and the surgeon's gestures are guided by real-time overlaying of the X-ray imagery in the microscope. During the device's progression inside the brain, the focus is ensured by the microscope auto-focus feature. The surgeon can thus constantly check his position on the field workstation. Obstacles to avoid or dangerous areas can be previewed in the operation field. This system is routinely used for 5 years in the neurosurgery division of the Val de Grace hospital. More than 400 brain surgery operations have been done using it. An adaptation is used for rachis surgery. Other military hospitals begin to be equipped with similar systems. It will be possible to link them for data transfer. When it will be operational, such a network it will show what could be, in the future, a medical/surgical remote-assistance system designed to take care of wounded/critical conditions people, including assistance to surgical gestures. (authors)

  14. Characterization and evaluation of ionizing and non-ionizing imaging systems used in state of the art image-guided radiation therapy techniques

    Science.gov (United States)

    Stanley, Dennis Nichols

    the stability of the imaging systems and characterize each system are important to ensuring the consistency and effectiveness of the overall treatment. Image-Guided Radiation Therapy quality assurance allows a method of quantifying the accuracy and stability of the imaging systems. Understanding how the ionizing imaging systems operate and change over time allows for a more effective overall treatment and will be the focus of the first step of this project. In each of the first three aims, different ionizing imaging modalities will be evaluated for their temporal stability and a record of the determined tolerance level will be reported. The Second step of this project will be a characterization of the accuracy and performance of the new C-Rad CatalystHD a video-based, surface-imaging guided patient localization system. The catalyst will be analyzed for it accuracy of setup and patient positing, intra- and inter- fraction motion detection as well as its respiratory gating capabilities. The final step of this project will be to use the well-established accuracy of the XVI volumetric imaging system as a benchmark to assess the accuracy of the C-Rad CatalystHD system for use in pretreatment patient position verification for cranial stereotactic procedures. The treatment of brain lesions generally requires a very high degree of precision due to relatively small target sizes, close proximity to eloquent areas of the brain, and large, ablative doses being delivered. Stringent accuracy in imaging is needed to verify and monitor the correct spatial delivery of radiation throughout treatment. In order to investigate if the CatalystHD system is a capable imaging system for such deliveries, the system will need to be assessed and benchmarked against the XVI in a phantom geometry. By doing so, the currently unproven utility of the CatalystHD system for cranial stereotactic delivery may be established. (Abstract shortened by ProQuest.).

  15. NASA Robotic Neurosurgery Testbed

    Science.gov (United States)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  16. NASA Robotic Neurosurgery Testbed

    Science.gov (United States)

    Mah, Robert

    1997-01-01

    The detection of tissue interface (e.g., normal tissue, cancer, tumor) has been limited clinically to tactile feedback, temperature monitoring, and the use of a miniature ultrasound probe for tissue differentiation during surgical operations, In neurosurgery, the needle used in the standard stereotactic CT or MRI guided brain biopsy provides no information about the tissue being sampled. The tissue sampled depends entirely upon the accuracy with which the localization provided by the preoperative CT or MRI scan is translated to the intracranial biopsy site. In addition, no information about the tissue being traversed by the needle (e.g., a blood vessel) is provided. Hemorrhage due to the biopsy needle tearing a blood vessel within the brain is the most devastating complication of stereotactic CT/MRI guided brain biopsy. A robotic neurosurgery testbed has been developed at NASA Ames Research Center as a spin-off of technologies from space, aeronautics and medical programs. The invention entitled "Robotic Neurosurgery Leading to Multimodality Devices for Tissue Identification" is nearing a state ready for commercialization. The devices will: 1) improve diagnostic accuracy and precision of general surgery, with near term emphasis on stereotactic brain biopsy, 2) automate tissue identification, with near term emphasis on stereotactic brain biopsy, to permit remote control of the procedure, and 3) reduce morbidity for stereotactic brain biopsy. The commercial impact from this work is the potential development of a whole new generation of smart surgical tools to increase the safety, accuracy and efficiency of surgical procedures. Other potential markets include smart surgical tools for tumor ablation in neurosurgery, general exploratory surgery, prostate cancer surgery, and breast cancer surgery.

  17. Clinical efficacy and safety of surface imaging guided radiosurgery (SIG-RS) in the treatment of benign skull base tumors.

    Science.gov (United States)

    Lau, Steven K M; Patel, Kunal; Kim, Teddy; Knipprath, Erik; Kim, Gwe-Ya; Cerviño, Laura I; Lawson, Joshua D; Murphy, Kevin T; Sanghvi, Parag; Carter, Bob S; Chen, Clark C

    2017-04-01

    Frameless, surface imaging guided radiosurgery (SIG-RS) is a novel platform for stereotactic radiosurgery (SRS) wherein patient positioning is monitored in real-time through infra-red camera tracking of facial topography. Here we describe our initial clinical experience with SIG-RS for the treatment of benign neoplasms of the skull base. We identified 48 patients with benign skull base tumors consecutively treated with SIG-RS at a single institution between 2009 and 2011. Patients were diagnosed with meningioma (n = 22), vestibular schwannoma (n = 20), or nonfunctional pituitary adenoma (n = 6). Local control and treatment-related toxicity were retrospectively assessed. Median follow-up was 65 months (range 61-72 months). Prescription doses were 12-13 Gy in a single fraction (n = 18), 8 Gy × 3 fractions (n = 6), and 5 Gy × 5 fractions (n = 24). Actuarial tumor control rate at 5 years was 98%. No grade ≥3 treatment-related toxicity was observed. Grade ≤2 toxicity was associated with symptomatic lesions (p = 0.049) and single fraction treatment (p = 0.005). SIG-RS for benign skull base tumors produces clinical outcomes comparable to conventional frame-based SRS techniques while enhancing patient comfort.

  18. Image-guided ablation therapy of bone tumors.

    Science.gov (United States)

    Sabharwal, Tarun; Katsanos, Konstantinos; Buy, Xavier; Gangi, Afshin

    2009-04-01

    A wide range of thermal and cryoablation methods is currently available for the curative eradication or palliative treatment of a variety of bone and soft-tissue tumors. Radiofrequency ablation has been developed as a multipurpose tool for the skeletal system. Cryoablation has the added advantages of direct computed tomography or magnetic resonance visualization and monitoring of treatment outcome with less peri- and postoperative pain. Use of appropriate thermo-sensors and insulation techniques, like carbon dioxide insufflation, results in enhanced safety and efficacy. Ablation of weight-bearing bones has to be supplemented with cement consolidation. The authors present an overview of the current status of percutaneous image-guided ablation therapy of bone and soft-tissue tumors, analyze the merits and limitations of the various systems available, and discuss possible new applications for the future.

  19. 3D ultrasound imaging in image-guided intervention.

    Science.gov (United States)

    Fenster, Aaron; Bax, Jeff; Neshat, Hamid; Cool, Derek; Kakani, Nirmal; Romagnoli, Cesare

    2014-01-01

    Ultrasound imaging is used extensively in diagnosis and image-guidance for interventions of human diseases. However, conventional 2D ultrasound suffers from limitations since it can only provide 2D images of 3-dimensional structures in the body. Thus, measurement of organ size is variable, and guidance of interventions is limited, as the physician is required to mentally reconstruct the 3-dimensional anatomy using 2D views. Over the past 20 years, a number of 3-dimensional ultrasound imaging approaches have been developed. We have developed an approach that is based on a mechanical mechanism to move any conventional ultrasound transducer while 2D images are collected rapidly and reconstructed into a 3D image. In this presentation, 3D ultrasound imaging approaches will be described for use in image-guided interventions.

  20. [Image-guided endoscopic transsphenoidal removal of pituitary adenoma].

    Science.gov (United States)

    Zhang, Qui-Hang; Liu, Hai-Sheng; Yang, Da-Zhang; Cheng, Jing-Yu

    2005-01-01

    To assess the role of neuronavigation in assisting endoscopic transsphenoidal surgery for pituitary adenomas. Ten endoscopic endonasal transsphenoidal reoperations for pituitary adenomas were selected. Clinical records were reviewed retrospectively. Five of 10 patients had gigantic adenoma, 3 microadenoma, 2 large adenoma. The mean setup time was 5 minutes, and the operative time was 50 minutes in image-guided procedures. In all cases, the system worked well without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of intraoperative accuracy in the axial, coronal, and.sagittal planes indicated a mean verified system error of 1.5 mm. for pituitary adenomas. After operation, the symptoms relieved in all patients. Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and safer.

  1. Stereotactic radiotherapy for vestibular schwannoma

    DEFF Research Database (Denmark)

    Muzevic, Dario; Legcevic, Jelena; Splavski, Bruno;

    2014-01-01

    ; Web of Science; CAB Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the search was 24 July 2014. SELECTION CRITERIA: Randomised controlled trials (RCTs) exploring the efficacy of stereotactic radiotherapy compared with observation alone, microsurgical...

  2. Intraoperative magnetic resonance imaging-conditional robotic devices for therapy and diagnosis.

    Science.gov (United States)

    Fisher, Taylor; Hamed, Abbi; Vartholomeos, Panagiotis; Masamune, Ken; Tang, Guoyi; Ren, Hongliang; Tse, Zion T H

    2014-03-01

    Magnetic resonance imaging presents high-resolution preoperative scans of target tissue and allows for the availability of intraoperative real-time images without the exposure of patients to ionizing radiation. This has motivated scientists and engineers to integrate medical robotics with the magnetic resonance imaging modality to allow robot-assisted, image-guided diagnosis and therapy. This article provides a review of the state-of-the-art medical robotic systems available for use in conjunction with intraoperative magnetic resonance imaging. The robot functionalities and mechanical designs for a wide range of magnetic resonance imaging interventions are presented, including their magnetic resonance imaging compatibility, actuation, kinematics and the mechanical and electrical designs of the robots. Classification and comparative study of various intraoperative magnetic resonance image guided robotic systems are provided. The robotic systems reviewed are summarized in a table in detail. Current technologies for magnetic resonance imaging-conditional robotics are reviewed and their potential future directions are sketched.

  3. Multifunctional magnetic nanoparticles for magnetic resonance image-guided photothermal therapy for cancer

    Science.gov (United States)

    Yue, Xiu-Li; Ma, Fang; Dai, Zhi-Fei

    2014-04-01

    Key advances in multifunctional magnetic nanoparticles (MNPs) for magnetic resonance (MR) image-guided photothermal therapy of cancer are reviewed. We briefly outline the design and fabrication of such multifunctional MNPs. Bimodal image-guided photothermal therapies (MR/fluorescence and MR/ultrasound) are also discussed.

  4. Simultaneous deblurring and iterative reconstruction of CBCT for image guided brain radiosurgery

    Science.gov (United States)

    Hashemi, SayedMasoud; Song, William Y.; Sahgal, Arjun; Lee, Young; Huynh, Christopher; Grouza, Vladimir; Nordström, Håkan; Eriksson, Markus; Dorenlot, Antoine; Régis, Jean Marie; Mainprize, James G.; Ruschin, Mark

    2017-04-01

    One of the limiting factors in cone-beam CT (CBCT) image quality is system blur, caused by detector response, x-ray source focal spot size, azimuthal blurring, and reconstruction algorithm. In this work, we develop a novel iterative reconstruction algorithm that improves spatial resolution by explicitly accounting for image unsharpness caused by different factors in the reconstruction formulation. While the model-based iterative reconstruction techniques use prior information about the detector response and x-ray source, our proposed technique uses a simple measurable blurring model. In our reconstruction algorithm, denoted as simultaneous deblurring and iterative reconstruction (SDIR), the blur kernel can be estimated using the modulation transfer function (MTF) slice of the CatPhan phantom or any other MTF phantom, such as wire phantoms. The proposed image reconstruction formulation includes two regularization terms: (1) total variation (TV) and (2) nonlocal regularization, solved with a split Bregman augmented Lagrangian iterative method. The SDIR formulation preserves edges, eases the parameter adjustments to achieve both high spatial resolution and low noise variances, and reduces the staircase effect caused by regular TV-penalized iterative algorithms. The proposed algorithm is optimized for a point-of-care head CBCT unit for image-guided radiosurgery and is tested with CatPhan phantom, an anthropomorphic head phantom, and 6 clinical brain stereotactic radiosurgery cases. Our experiments indicate that SDIR outperforms the conventional filtered back projection and TV penalized simultaneous algebraic reconstruction technique methods (represented by adaptive steepest-descent POCS algorithm, ASD-POCS) in terms of MTF and line pair resolution, and retains the favorable properties of the standard TV-based iterative reconstruction algorithms in improving the contrast and reducing the reconstruction artifacts. It improves the visibility of the high contrast details

  5. Dosimetric Comparison of Real-Time MRI-Guided Tri-Cobalt-60 Versus Linear Accelerator-Based Stereotactic Body Radiation Therapy Lung Cancer Plans.

    Science.gov (United States)

    Wojcieszynski, Andrzej P; Hill, Patrick M; Rosenberg, Stephen A; Hullett, Craig R; Labby, Zacariah E; Paliwal, Bhudatt; Geurts, Mark W; Bayliss, R Adam; Bayouth, John E; Harari, Paul M; Bassetti, Michael F; Baschnagel, Andrew M

    2017-06-01

    Magnetic resonance imaging-guided radiation therapy has entered clinical practice at several major treatment centers. Treatment of early-stage non-small cell lung cancer with stereotactic body radiation therapy is one potential application of this modality, as some form of respiratory motion management is important to address. We hypothesize that magnetic resonance imaging-guided tri-cobalt-60 radiation therapy can be used to generate clinically acceptable stereotactic body radiation therapy treatment plans. Here, we report on a dosimetric comparison between magnetic resonance imaging-guided radiation therapy plans and internal target volume-based plans utilizing volumetric-modulated arc therapy. Ten patients with early-stage non-small cell lung cancer who underwent radiation therapy planning and treatment were studied. Following 4-dimensional computed tomography, patient images were used to generate clinically deliverable plans. For volumetric-modulated arc therapy plans, the planning tumor volume was defined as an internal target volume + 0.5 cm. For magnetic resonance imaging-guided plans, a single mid-inspiratory cycle was used to define a gross tumor volume, then expanded 0.3 cm to the planning tumor volume. Treatment plan parameters were compared. Planning tumor volumes trended larger for volumetric-modulated arc therapy-based plans, with a mean planning tumor volume of 47.4 mL versus 24.8 mL for magnetic resonance imaging-guided plans ( P = .08). Clinically acceptable plans were achievable via both methods, with bilateral lung V20, 3.9% versus 4.8% ( P = .62). The volume of chest wall receiving greater than 30 Gy was also similar, 22.1 versus 19.8 mL ( P = .78), as were all other parameters commonly used for lung stereotactic body radiation therapy. The ratio of the 50% isodose volume to planning tumor volume was lower in volumetric-modulated arc therapy plans, 4.19 versus 10.0 ( P plans, 1.25 versus 1.25 ( P = .98). Magnetic resonance imaging-guided tri

  6. Stereotactic Radiosurgery (SRS) / Stereotactic body radiotherapy (SBRT): Benefit to Irish patients and Irish Healthcare Economy

    LENUS (Irish Health Repository)

    Cagney, DN

    2017-01-01

    Cancer incidence across Europe is projected to rise rapidly over the next decade. This rising cancer incidence is mirrored by increasing use of and indications for stereotactic radiation. This paper seeks to summarize the exponential increase in indications for stereotactic radiotherapy as well as the evolving economic advantages of stereotactic radiosurgery and stereotactic body radiotherapy

  7. Photoacoustic image-guided drug delivery in the prostate

    Science.gov (United States)

    Tang, Shanshan; Chen, Jian; Samant, Pratik; Xiang, Liangzhong

    2016-03-01

    Image guided drug delivery is a novel strategy that combines the effect of therapy and visibility into one system. Here we apply photoacoustic (PA) imaging to visualize the drug delivery process, and perform a simulation study on monitoring the photosensitizer concentration in a prostate tumor during photodynamic therapy (PDT). A 3D optical model of the human prostate is developed, and the light absorption distribution in the prostate is estimated by the Monte Carlo simulation method. The filtered back-projection algorithm is used to reconstruct PA images. PA images of transurethral laser/transrectal ultrasound are compared to those of transrectal laser/ultrasound. Results show that the transurethral laser has a better penetration depth in the prostate compared with transrectal one. Urethral thermal safety is investigated via COMSOL Multiphysics, and the results show that the proposed pulsed transurethral laser will cause no thermal damage on the urethral surface. Regression analysis for PA signal amplitude and drug concentration demonstrates that the PA technique has the potential to monitor drug distributions in PDT, as well as in other laser-based prostate therapy modalities.

  8. Fluoroscopic image-guided intervention system for transbronchial localization

    Science.gov (United States)

    Rai, Lav; Keast, Thomas M.; Wibowo, Henky; Yu, Kun-Chang; Draper, Jeffrey W.; Gibbs, Jason D.

    2012-02-01

    Reliable transbronchial access of peripheral lung lesions is desirable for the diagnosis and potential treatment of lung cancer. This procedure can be difficult, however, because accessory devices (e.g., needle or forceps) cannot be reliably localized while deployed. We present a fluoroscopic image-guided intervention (IGI) system for tracking such bronchoscopic accessories. Fluoroscopy, an imaging technology currently utilized by many bronchoscopists, has a fundamental shortcoming - many lung lesions are invisible in its images. Our IGI system aligns a digitally reconstructed radiograph (DRR) defined from a pre-operative computed tomography (CT) scan with live fluoroscopic images. Radiopaque accessory devices are readily apparent in fluoroscopic video, while lesions lacking a fluoroscopic signature but identifiable in the CT scan are superimposed in the scene. The IGI system processing steps consist of: (1) calibrating the fluoroscopic imaging system; (2) registering the CT anatomy with its depiction in the fluoroscopic scene; (3) optical tracking to continually update the DRR and target positions as the fluoroscope is moved about the patient. The end result is a continuous correlation of the DRR and projected targets with the anatomy depicted in the live fluoroscopic video feed. Because both targets and bronchoscopic devices are readily apparent in arbitrary fluoroscopic orientations, multiplane guidance is straightforward. The system tracks in real-time with no computational lag. We have measured a mean projected tracking accuracy of 1.0 mm in a phantom and present results from an in vivo animal study.

  9. Image-guided interventional therapy for cancer with radiotherapeutic nanoparticles✩

    Science.gov (United States)

    Phillips, William T.; Bao, Ande; Brenner, Andrew J.; Goins, Beth A.

    2015-01-01

    One of the major limitations of current cancer therapy is the inability to deliver tumoricidal agents throughout the entire tumor mass using traditional intravenous administration. Nanoparticles carrying beta-emitting therapeutic radionuclides that are delivered using advanced image-guidance have significant potential to improve solid tumor therapy. The use of image-guidance in combination with nanoparticle carriers can improve the delivery of localized radiation to tumors. Nanoparticles labeled with certain beta-emitting radionuclides are intrinsically theranostic agents that can provide information regarding distribution and regional dosimetry within the tumor and the body. Image-guided thermal therapy results in increased uptake of intravenous nanoparticles within tumors, improving therapy. In addition, nanoparticles are ideal carriers for direct intratumoral infusion of beta-emitting radionuclides by convection enhanced delivery, permitting the delivery of localized therapeutic radiation without the requirement of the radionuclide exiting from the nanoparticle. With this approach, very high doses of radiation can be delivered to solid tumors while sparing normal organs. Recent technological developments in image-guidance, convection enhanced delivery and newly developed nanoparticles carrying beta-emitting radionuclides will be reviewed. Examples will be shown describing how this new approach has promise for the treatment of brain, head and neck, and other types of solid tumors. PMID:25016083

  10. Image-guided conservative management of right colonic diverticulitis

    Institute of Scientific and Technical Information of China (English)

    Sun Jin Park; Sung Il Choi; Suk Hwan Lee; Kil Yeon Lee

    2009-01-01

    AIM: To study the clinical outcomes of medical therapy in patients with right colonic diverticulitis. METHODS: The records of 189 patients with right colonic diverticulitis which was finally diagnosed by computed tomography, ultrasonography, or operative findings were retrospectively reviewed. RESULTS: Of the 189 patients hospitalized for right colonic diverticulitis, the stages of diverticulitis by a modified Hinchey classification were 26 patients (13.8%) in stage 0, 139 patients (73.5%) in stage Ⅰ a, 23 patients (12.2%) in stage Ⅰb, and 1 patient (0.5%) in stage Ⅲ. Medical therapy was undertaken in 185 of 189 patients (97.9%). One hundred and eighty three of 185 patients were successfully treated with bowel rest and antibiotics. Two patients in stage Ⅰb required a resection or surgical drainage because of an inadequate response to conservative treatment. Recurrent diverticulitis developed in 15 of 183 patients (8.2%) who responded to medicaltherapy. All 15 patients who suffered a second attack had uncomplicated diverticulitis, and were successfully treated with medical therapy. CONCLUSION: Our results indicate that right colonic diverticulitis is essentially benign and image-guided conservative treatment is primarily required.

  11. Photoacoustic image-guided navigation system for surgery (Conference Presentation)

    Science.gov (United States)

    Park, Sara; Jang, Jongseong; Kim, Jeesu; Kim, Young Soo; Kim, Chulhong

    2017-03-01

    Identifying and delineating invisible anatomical and pathological details during surgery guides surgical procedures in real time. Various intraoperative imaging modalities have been increasingly employed to minimize such surgical risks as anatomical changes, damage to normal tissues, and human error. However, current methods provide only structural information, which cannot identify critical structures such as blood vessels. The logical next step is an intraoperative imaging modality that can provide functional information. Here, we have successfully developed a photoacoustic (PA) image-guided navigation system for surgery by integrating a position tracking system and a real-time clinical photoacoustic/ultrasound (PA/US) imaging system. PA/US images were acquired in real time and overlaid on pre-acquired cross-sectional magnetic resonance (MR) images. In the overlaid images, PA images represent the optical absorption characteristics of the surgical field, while US and MR images represent the morphological structure of surrounding tissues. To test the feasibility of the system, we prepared a tissue mimicking phantom which contained two samples, methylene blue as a contrast agent and water as a control. We acquired real-time overlaid PA/US/MR images of the phantom, which were well-matched with the optical and morphological properties of the samples. The developed system is the first approach to a novel intraoperative imaging technology based on PA imaging, and we believe that the system can be utilized in various surgical environments in the near future, improving the efficacy of surgical guidance.

  12. Frameless image-guided radiosurgery for trigeminal neuralgia

    Science.gov (United States)

    Shields, Lisa B. E.; Shanks, Todd S.; Shearer, Andrew J.; Shelton, Lauren A.; Shelton, Brent J.; Howe, Jonathan; Coons, James M.; Plato, Brian; Spalding, Aaron C.

    2017-01-01

    Background: Frameless image-guided radiosurgery (IGRS) is a safe and effective noninvasive treatment for trigeminal neuralgia (TN). This study evaluates the use of frameless IGRS to treat patients with refractory TN. Methods: We reviewed the records of 20 patients diagnosed with TN who underwent frameless IGRS treatments between March 2012 and December 2013. Facial pain was graded using the Barrow Neurological Institute (BNI) scoring system. The initial setup uncertainty from simulation to treatment and the patient intrafraction uncertainty were measured. The median follow-up was 32 months. Results: All patients’ pain was BNI Grade IV or V before the frameless IGRS treatment. The mean intrafraction shift was 0.43 mm (0.28–0.76 mm), and the maximum intrafraction shift was 0.95 mm (0.53–1.99 mm). At last follow-up, 8 (40%) patients no longer required medications (BNI 1 or 2), 11 (55%) patients were pain free but required medication (BNI 3), and 1 (5%) patient had no pain relief (BNI 5). Patients who did not have prior surgery had a higher odds ratio for pain relief compared to patients who had prior surgery (14.9, P = 0.0408). Conclusions: Frameless IGRS provides comparable dosimetric and clinical outcomes to frame-based SRS in a noninvasive fashion for patients with medically refractory TN. PMID:28607821

  13. Image guided placement of temporary anchorage devices for tooth movement

    Energy Technology Data Exchange (ETDEWEB)

    Bahl-Palomo, L.; Bissada, N. [Case Western Reserve Univ. School of Dental Medicine, Dept. of Periodontics, Cleveland, OH (United States); Palomo, J.M.; Hans, M.G. [Case Western Reserve Univ. School of Dental Medicine, Dept. of Orthodontics, Cleveland, OH (United States)

    2007-06-15

    The aim of this project is to develop an image guided protocol for placement of a temporary anchorage device without surgically reflecting a mucoperiosteal flap. Eighteen orthodontic cases were selected for skeletal anchorage from the department of orthodontics at Case University. CBCT images of the subjects were taken using the Hitachi CB MercuRay system set at 15 mA, 120 kVp. CBCT images evaluated the ideal location for TAD placement in three dimensions. Horizontal and vertical linear measurements were taken from fixed dental landmarks to clearly define the location for placement. Transverse slices were used to evaluate the thickness of the buccal plate. Using the transverse view, the angle of insertion was determined such that the maximum buccal plate surface area would contact the screw. TADs were placed in the optimum location, with the most appropriate angle of insertion using a closed approach and with minimal local anesthesia and without flap elevation. Results: All TADs were placed without anatomic encroachment and enabled fixed orthodontic anchorage. (orig.)

  14. TU-A-304-01: Introduction and Workflow of Image-Guided SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Salter, B. [University of Utah Huntsman Cancer Institute (United States)

    2015-06-15

    Increased use of SBRT and hypo fractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide updated knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT or IMRT, and technical advancements in QA of SBRT (in particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional (3D and 4D) and multi-modality (CT, beam-level X-ray imaging, pre- and on-treatment 3D/4D MRI, PET, robotic ultrasound, etc.) for reliable guidance of SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. Discuss treatment planning and quality assurance issues specific to SBRT. Research grant from Varian Medical Systems.

  15. Virtual rigid body: a new optical tracking paradigm in image-guided interventions

    Science.gov (United States)

    Cheng, Alexis; Lee, David S.; Deshmukh, Nishikant; Boctor, Emad M.

    2015-03-01

    Tracking technology is often necessary for image-guided surgical interventions. Optical tracking is one the options, but it suffers from line of sight and workspace limitations. Optical tracking is accomplished by attaching a rigid body marker, having a pattern for pose detection, onto a tool or device. A larger rigid body results in more accurate tracking, but at the same time large size limits its usage in a crowded surgical workspace. This work presents a prototype of a novel optical tracking method using a virtual rigid body (VRB). We define the VRB as a 3D rigid body marker in the form of pattern on a surface generated from a light source. Its pose can be recovered by observing the projected pattern with a stereo-camera system. The rigid body's size is no longer physically limited as we can manufacture small size light sources. Conventional optical tracking also requires line of sight to the rigid body. VRB overcomes these limitations by detecting a pattern projected onto the surface. We can project the pattern onto a region of interest, allowing the pattern to always be in the view of the optical tracker. This helps to decrease the occurrence of occlusions. This manuscript describes the method and results compared with conventional optical tracking in an experiment setup using known motions. The experiments are done using an optical tracker and a linear-stage, resulting in targeting errors of 0.38mm+/-0.28mm with our method compared to 0.23mm+/-0.22mm with conventional optical markers. Another experiment that replaced the linear stage with a robot arm resulted in rotational errors of 0.50+/-0.31° and 2.68+/-2.20° and the translation errors of 0.18+/-0.10 mm and 0.03+/-0.02 mm respectively.

  16. Stereotactic radiosurgery for trigeminal neuralgia utilizing the BrainLAB Novalis system.

    Science.gov (United States)

    Zahra, Hadi; Teh, Bin S; Paulino, Arnold C; Yoshor, Daniel; Trask, Todd; Baskin, David; Butler, E Brian

    2009-12-01

    Stereotactic radiosurgery (SRS) is one of the least invasive treatments for trigeminal neuralgia (TN). To date, most reports have been about Cobalt-based treatments (i.e., Gamma Knife) with limited data on image-guided stereotactic linear accelerator treatments. We describe our initial experience of using BrainLAB Novalis stereotactic system for the radiosurgical treatment of TN. A total of 20 patients were treated between July 2004 and February 2007. Each SRS procedure was performed using the BrainLAB Novalis System. Thin cuts MRI images of 1.5 mm thickness were acquired and fused with the simulation CT of each patient. Majority of the patients received a maximum dose of 90 Gy. The median brainstem dose to 1.0 cc and 0.1 cc was 2.3 Gy and 13.5 Gy, respectively. In addition, specially acquired three-dimensional fast imaging sequence employing steady-state acquisition (FIESTA) MRI was utilized to improve target delineation of the trigeminal proximal nerve root entry zone. Barrow Neurological Index (BNI) pain scale for TN was used for assessing treatment outcome. At a median follow-up time of 14.2 months, 19 patients (95%) reported at least some improvement in pain. Eight (40%) patients were completely pain-free and stopped all medications (BNI Grade I) while another 2 (10%) patients also stopped medications but reported occasional pain (BNI Grade II). Another 2 (10%) patients reported no pain and 7 (35%) patients only occasional pain while continuing medications, BNI Grade IIIA and IIIB, respectively. Median time to pain control was 8.5 days (range: 1-70 days). No patient reported severe pain, worsening pain or any pain not controlled on their previously taken medication. Intermittent or persistent facial numbness following treatments occurred in 35% of patients. No other complications were reported. Stereotactic radiosurgery using the BrainLAB Novalis system is a safe and effective treatment for TN. This information is important as more centers are obtaining image-guided

  17. Stereotactic body radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Simon S. [Univ. Hospitals Seidman Cancer Center, Cleveland, OH (United States). Dept. of Radiation Oncology; Case Western Reserve Univ., Cleveland, OH (United States). Case Comprehensive Cancer Center; Teh, Bin S. [The Methodist Hospital Cancer Center and Research Institute, Houston, TX (United States). Weill Cornell Medical College; Lu, Jiade J. [National Univ. of Singapore (Singapore). Dept. of Radiation Oncology; Schefter, Tracey E. (eds.) [Colorado Univ., Aurora, CO (United States). Dept. of Radiation Oncology

    2012-11-01

    Comprehensive an up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. Examines in detail retrospective studies and prospective clinical trials for various organ sites from around the world. Written by world-renowned experts in SBRT from North America, Asia and Europe. Stereotactic body radiation therapy (SBRT) has emerged as an innovative treatment for various primary and metastatic cancers, and the past five years have witnessed a quantum leap in its use. This book provides a comprehensive and up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. It will serve as a detailed resource for this rapidly developing treatment modality. The organ sites covered include lung, liver, spine, pancreas, prostate, adrenal, head and neck, and female reproductive tract. Retrospective studies and prospective clinical trials on SBRT for various organ sites from around the world are examined, and toxicities and normal tissue constraints are discussed. This book features unique insights from world-renowned experts in SBRT from North America, Asia, and Europe. It will be necessary reading for radiation oncologists, radiation oncology residents and fellows, medical physicists, medical physics residents, medical oncologists, surgical oncologists, and cancer scientists.

  18. Extreme Hypofractionated Image-Guided Radiotherapy for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Carlo Greco

    2013-09-01

    Full Text Available An emerging body of data suggests that hypofractionated radiation schedules, where a higher dose per fraction is delivered in a smaller number of sessions, may be superior to conventional fractionation schemes in terms of both tumour control and toxicity profile in the management of adenocarcinoma of the prostate. However, the optimal hypofractionation scheme is still the subject of scientific debate. Modern computer-driven technology enables the safe implementation of extreme hypo fractionation (often referred to as stereotactic body radiation therapy [SBRT]. Several studies are currently being conducted to clarify the yet unresolved issues regarding treatment techniques and fractionation regimens. Recently, the American Society for Radiation Oncology (ASTRO issued a model policy indicating that data supporting the use of SBRT for prostate cancer have matured to a point where SBRT could be considered an appropriate alternative for select patients with low-to-intermediate risk disease. The present article reviews some of the currently available data and examines the impact of tracking technology to mitigate intra-fraction target motion, thus, potentially further improving the clinical outcomes of extreme hypofractionated radiation therapy in appropriately selected prostate cancer patients. The Champalimaud Centre for the Unknown (CCU’s currently ongoing Phase I feasibility study is described; it delivers 45 Gy in five fractions using prostate fixation via a rectal balloon, and urethral sparing via catheter placement with on-line intra-fractional motion tracking through beacon transponder technology.

  19. Individualized image guided iso-NTCP based liver cancer SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Dawson, Laura A.; Eccles, Cynthia; Craig, Tim [Princess Margaret Hospital, Toronto (Canada). Radiation Medicine Program

    2006-09-15

    A highly individualized stereotactic body radiotherapy (SBRT) strategy was developed to allow a wide spectrum of patients with liver cancer to be treated. This phase I/II study encompasses individualization of immobilization, radiation planning, PTV margin determination, image guidance strategy and prescription dose. Active breathing control breath hold is used to immobilize the liver when feasible. Image guidance strategies include orthogonal MV images and orthogonal kV fluoroscopy using the diaphragm for a surrogate for the liver, and kV cone beam CT using the liver or tumour for guidance. The prescription dose is individualized to maintain the same estimated risk of radiation-induced liver disease (RILD), based on a normal tissue complication probability (NTCP) model, with a maximum permitted dose of 60 Gy in 6 fractions. Since August 2003, 79 patients with hepatocellular carcinoma (33), intrahepatic cholangiocarcinoma (12) and liver metastases (34) were treated. The median tumour volume was 293 cm{sup 3} (2.9-3088 cm{sup 3}). The median prescribed dose was 36.6 Gy (24.0 Gy-57.0 Gy) in 6 fractions. The median effective liver volume irradiated was 45% (9-80%). Sixty percent of patients were treated with breath hold to immobilize their liver. Intra-fraction reproducibility (s) of the liver with repeat breath holds was excellent (1.5?mm); however inter-fraction reproducibility (s) was worse (3.4 mm). Image guidance reduced the residual systematic and random setup errors significantly.

  20. Frequency of complications in image guided percutaneous nephrostomy.

    Science.gov (United States)

    Ali, Syed Mubarak; Mehmood, Khalid; Faiq, Syed Muhammed; Ali, Bux; Naqvi, Syed Ali Anwar; Rizvi, Adib-ul-Hasan

    2013-07-01

    To assess the frequency of complications in image-guided percutaneous nephrostomy and to identify common sources of error. The study was carried out at the Sindh Institute of Urology and Transplantation, Karachi, between November 2006 and May 2007. Patients of all age groups between 1 and 80 years were included using nonprobability convenience sampling technique. Those suffering from obstructive uropathy due to various causes were diagnosed by imaging modalities like ultrasound, computed tomography scan, conventional X-ray and contrast studies. It also included cases where percutaneous nephrostomy was used to temporarily divert urine in the presence of urinary tract leaks and fistula so that healing may occur. Patients with uncorrectable bleeding diathesis were excluded. Nephrostomies performed for supplementary procedures were also excluded. One-month follow-up was performed by means of direct communications and using various imaging modalities. SPSS 12 was used for statistical analysis. Three hundred patients enrolled in the study. The procedure was successful in all encounters. The complications were categorised as early and late complications. Early complications were sepsis in 6 (2%) patients, retroperitoneal haematoma in 5 (1.6%) patients, bleeding in 2 (0.6%), and urinoma in 1 (0.3%). Late complications included catheter blockage in 15 (5%) patients, and dislodgement of catheter in 7 (2.3%). Total early complications were noted in 14 (4.66%) patients, and there were 22 (7.33%) late complications. Percutaneous nephrostomy is a safe, simple and cost-effective technique with low morbidity and no major life-threatening complications.

  1. A novel multiwavelength fluorescence image-guided surgery imaging system

    Science.gov (United States)

    Volpi, D.; Tullis, I. D. C.; Laios, A.; Pathiraja, P. N. J.; Haldar, K.; Ahmed, A. A.; Vojnovic, B.

    2014-02-01

    We describe the development and performance analysis of two clinical near-infrared fluorescence image-guided surgery (FIGS) devices that aim to overcome some of the limitations of current FIGS systems. The devices operate in a widefield-imaging mode and can work (1) in conjunction with a laparoscope, during minimally invasive surgery, and (2) as a hand-held, open surgery imaging system. In both cases, narrow-band excitation light, delivered at multiple wavelengths, is efficiently combined with white reflectance light. Light is delivered to ~100 cm2 surgical field at 1-2 mW/cm2 for white light and 3-7 mW/cm2 (depending on wavelength) of red - near infrared excitation, at a typical working distance of 350 mm for the hand-held device and 100 mm for the laparoscope. A single, sensitive, miniaturized color camera collects both fluorescence and white reflectance light. The use of a single imager eliminates image alignment and software overlay complexity. A novel filtering and illumination arrangement allows simultaneous detection of white reflectance and fluorescence emission from multiple dyes in real-time. We will present both fluorescence detection sensitivity modeling and practical performance data. We have demonstrated the efficiency and the advantages of the devices both pre-clinically and during live surgery on humans. Both the hand-held and the laparoscopic systems have proved to be reliable and beneficial in an ongoing clinical trial involving sentinel lymph node detection in gynecological cancers. We will show preliminary results using two clinically approved dyes, Methylene blue and indocyanine green. We anticipate that this technology can be integrated and routinely used in a larger variety of surgical procedures.

  2. Navigation concepts for magnetic resonance imaging-guided musculoskeletal interventions.

    Science.gov (United States)

    Busse, Harald; Kahn, Thomas; Moche, Michael

    2011-08-01

    Image-guided musculoskeletal (MSK) interventions are a widely used alternative to open surgical procedures for various pathological findings in different body regions. They traditionally involve one of the established x-ray imaging techniques (radiography, fluoroscopy, computed tomography) or ultrasound scanning. Over the last decades, magnetic resonance imaging (MRI) has evolved into one of the most powerful diagnostic tools for nearly the whole body and has therefore been increasingly considered for interventional guidance as well.The strength of MRI for MSK applications is a combination of well-known general advantages, such as multiplanar and functional imaging capabilities, wide choice of tissue contrasts, and absence of ionizing radiation, as well as a number of MSK-specific factors, for example, the excellent depiction of soft-tissue tumors, nonosteolytic bone changes, and bone marrow lesions. On the downside, the magnetic resonance-compatible equipment needed, restricted space in the magnet, longer imaging times, and the more complex workflow have so far limited the number of MSK procedures under MRI guidance.Navigation solutions are generally a natural extension of any interventional imaging system, in particular, because powerful hardware and software for image processing have become routinely available. They help to identify proper access paths, provide accurate feedback on the instrument positions, facilitate the workflow in an MRI environment, and ultimately contribute to procedural safety and success.The purposes of this work were to describe some basic concepts and devices for MRI guidance of MSK procedures and to discuss technical and clinical achievements and challenges for some selected implementations.

  3. CyberKnife stereotactic radiotherapy as monotherapy for low- to intermediate-stage prostate cancer: Early experience, feasibility, and tolerance

    NARCIS (Netherlands)

    S. Aluwini (Shafak); P.H. van Rooij (Peter); M.S. Hoogeman (Mischa); C.H. Bangma (Chris); W.J. Kirkels (Wim); L. Incrocci (Luca); I.-K.K. Kolkman-Deurloo (Inger-Karina)

    2010-01-01

    textabstractPurpose: The CyberKnife (CK), a linear accelerator mounted on a robotic device, enables excellent dose conformation to the target and minimizes dose to surrounding normal tissue. It is a very suitable device for performing hypofractionated stereotactic body radiotherapy as monotherapy fo

  4. Image guided versus palpation guided core needle biopsy of palpable breast masses: a prospective study

    Directory of Open Access Journals (Sweden)

    Smriti Hari

    2016-01-01

    Interpretation & conclusions: Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.

  5. Endoscopic image-guided thermal therapy using targeted near infrared fluorescent gold nanorods (Conference Presentation)

    Science.gov (United States)

    Elson, Daniel S.

    2016-09-01

    We present an in vivo study of endoscopic fluorescence image-guided photothermal therapy of human oesophageal adenocarcinoma in a murine xenograft model, using intratumoural or intravenous gold nanorods functionalised with Cy5.5 and EGFR.

  6. Photoacoustic and Ultrasonic Image-Guided Needle Biopsy of the Prostate

    Science.gov (United States)

    2015-10-01

    AWARD NUMBER: W81XWH-14-1-0024 TITLE: Photoacoustic and Ultrasonic Image-Guided Needle Biopsy of the Prostate PRINCIPAL INVESTIGATOR: Richard...light sources to yield multi-spectral photoacoustic (PA) imaging data in excised prostate tissue. Two types of interstitial sources – a directional...ANSI Std. Z39.18 Photoacoustic and Ultrasonic Image-Guided Needle Biopsy of the Prostate 34 Table of Contents Page 1. Introduction

  7. Health technology assessment of image-guided radiotherapy (IGRT): A systematic review of current evidence

    OpenAIRE

    Arabloo, Jalal; Hamouzadeh, Pejman; Mousavinezhad, Seyedeh Maryam; Mobinizadeh, Mohammadreza; Olyaeemanesh, Alireza; Pooyandjoo, Morvarid

    2016-01-01

    Background: Image-guided radiotherapy used multiple imaging during the radiation therapy course to improve the precision and accuracy of health care provider's treatment. Objectives: This study aims to assess the safety, effectiveness and economic aspects of image-guided radiation therapy for decision-making about this technology in Iran. Methods: In this study, the most important medical databases such as PubMed and Cochrane Library were searched until November 2014. The systematic reviews, ...

  8. Testicular Doses in Image-Guided Radiotherapy of Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Deng Jun, E-mail: jun.deng@yale.edu [Department of Therapeutic Radiology, Yale University, New Haven, CT (United States); Chen Zhe; Yu, James B.; Roberts, Kenneth B.; Peschel, Richard E.; Nath, Ravinder [Department of Therapeutic Radiology, Yale University, New Haven, CT (United States)

    2012-01-01

    Purpose: To investigate testicular doses contributed by kilovoltage cone-beam computed tomography (kVCBCT) during image-guided radiotherapy (IGRT) of prostate cancer. Methods and Materials: An EGS4 Monte Carlo code was used to calculate three-dimensional dose distributions from kVCBCT on 3 prostate cancer patients. Absorbed doses to various organs were compared between intensity-modulated radiotherapy (IMRT) treatments and kVCBCT scans. The impact of CBCT scanning mode, kilovoltage peak energy (kVp), and CBCT field span on dose deposition to testes and other organs was investigated. Results: In comparison with one 10-MV IMRT treatment, a 125-kV half-fan CBCT scan delivered 3.4, 3.8, 4.1, and 5.7 cGy to the prostate, rectum, bladder, and femoral heads, respectively, accounting for 1.7%, 3.2%, 3.2%, and 8.4% of megavoltage photon dose contributions. However, the testes received 2.9 cGy from the same CBCT scan, a threefold increase as compared with 0.7 cGy received during IMRT. With the same kVp, full-fan mode deposited much less dose to organs than half-fan mode, ranging from 9% less for prostate to 69% less for testes, except for rectum, where full-fan mode delivered 34% more dose. As photon beam energy increased from 60 to 125 kV, kVCBCT-contributed doses increased exponentially for all organs, irrespective of scanning mode. Reducing CBCT field span from 30 to 10 cm in the superior-inferior direction cut testicular doses from 5.7 to 0.2 cGy in half-fan mode and from 1.5 to 0.1 cGy in full-fan mode. Conclusions: Compared with IMRT, kVCBCT-contributed doses to the prostate, rectum, bladder, and femoral heads are clinically insignificant, whereas dose to the testes is threefold more. Full-fan CBCT usually deposits much less dose to organs (except for rectum) than half-fan mode in prostate patients. Kilovoltage CBCT-contributed doses increase exponentially with photon beam energy. Reducing CBCT field significantly cuts doses to testes and other organs.

  9. Stereotactic guidance for navigated percutaneous sacroiliac joint fusion.

    Science.gov (United States)

    Lee, Darrin J; Kim, Sung-Bum; Rosenthal, Philip; Panchal, Ripul R; Kim, Kee D

    2016-03-01

    Arthrodesis of the sacroiliac joint (SIJ) for surgical treatment of SIJ dysfunction has regained interest among spine specialists. Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement; however, image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement. In the following cases, we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm(®) multidimensional surgical imaging with StealthStation(®) navigation (Medtronic, Inc. Minneapolis, MN). Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site. O-arm(®) integrated with StealthStation(®) allowed immediate auto-registration. The skin incision was planned with an image-guidance probe. An image-guided awl, drill and tap were utilized to choose a starting point and trajectory. Threaded titanium cage(s) packed with autograft and/or allograft were then placed. O-arm(®) image-guidance allowed for implant placement in the SIJ with a small skin incision. However, we could not track the cage depth position with our current system, and in one patient, the SIJ cage had to be revised secondary to the anterior breach of sacrum. © 2016 by the Journal of Biomedical Research. All rights reserved.

  10. Exploratorium: Robots.

    Science.gov (United States)

    Brand, Judith, Ed.

    2002-01-01

    This issue of Exploratorium Magazine focuses on the topic robotics. It explains how to make a vibrating robotic bug and features articles on robots. Contents include: (1) "Where Robot Mice and Robot Men Run Round in Robot Towns" (Ray Bradbury); (2) "Robots at Work" (Jake Widman); (3) "Make a Vibrating Robotic Bug" (Modesto Tamez); (4) "The Robot…

  11. Image-guided pain therapy. Sympathicolysis; Bildgestuetzte Schmerztherapie. Sympathikolyse

    Energy Technology Data Exchange (ETDEWEB)

    Burbelko, M.; Wagner, H.J. [Vivantes Klinikum im Friedrichshain, Institut fuer Radiologie und Interventionelle Therapie, Berlin (Germany); Gutberlet, M.; Grothoff, M. [Universitaet Leipzig - Herzzentrum, Abteilung fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany)

    2015-06-15

    In the autonomic nerve system most sympathetic neurons synapse peripherally in the ganglia of the sympathetic trunk. A reduction in sympathicotonia by partial elimination of these ganglia is a therapeutic approach that has been used for more than 100 years. In the early 1920s the first attempts at percutaneous sympathicolysis (SL) were carried out. Nowadays, minimally invasive image-guided SL has become an integral part of interventional radiology. Established indications for SL are hyperhidrosis, critical limb ischemia and the complex regional pain syndrome. The standard imaging guidance modality in SL is computed tomography (CT) which allows the exact placement of the puncture needle in the target area under visualization of the surrounding structures. Ethanol is normally used for chemical lysis, which predominantly eliminates the unmyelinated autonomic axons. In order to visualize the distribution of the ethanol during application, iodine-containing contrast medium is added. The sympathetic nervous system (SNS) controls sweat secretion via the efferent neurons; therefore, effective therapy of idiopathic palmar, axillary and plantar hyperhidrosis can be achieved when SL is performed at the corresponding level of the sympathetic trunk. Furthermore, due to the vasomotor innervation of most blood vessels, by reduction of the sympathicotonus an atony of the smooth muscles and therefore vasodilatation occurs, which is used as a palliative therapeutic option in patients with critical limb ischemia. By elimination of the afferent sensory fibers this also results in pain relief. This principle is also used in the SL therapy of the complex regional pain syndrome. After the introduction of CT guidance, major complications have become rare events. In addition to the usual risks of percutaneous interventions there are, however, a number of specific complications, such as syncope caused by irritation of cardiac sympathetic nerves in thoracic SL and ureteral injury in lumbar

  12. Reduced rectal toxicity with ultrasound-based image guided radiotherapy using BAT trademark (B-mode acquisition and targeting system) for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bohrer, Markus; Schroeder, Peter; Welzel, Grit; Wertz, Hansjoerg; Lohr, Frank; Wenz, Frederik; Mai, Sabine Kathrin [University Medical Center, Mannheim (Germany). Dept. of Radiation Oncology

    2008-12-15

    To evaluate the effect of image guided radiotherapy with stereotactic ultrasound BAT (B-mode acquisition and targeting system) on rectal toxicity in conformal radiotherapy of prostate cancer. Patients and Methods 42 sequential patients with prostate cancer undergoing radiotherapy before and after the introduction of BAT were included. Planning computed tomography (CT) was performed with empty rectum and moderately filled bladder. The planning target volume (PTV) included the prostate and seminal vesicles with a safety margin of 1.5 cm in anterior and lateral direction. In posterior direction the anterior 1/3 of the rectum circumference were included. Total dose was 66 Gy and a boost of 4 Gy excluding the seminal vesicles. 22 patients (BAT group) were treated with daily stereotactic ultrasound positioning, for the other 20 patients (NoBAT group) an EPID (electronic portal imaging device) was performed once a week. Acute and late genito-urinary (GU) and rectal toxicity and PSA values were evaluated after 1.5, 3, 6, 9 and 12 months. The total median follow up of toxicity was 3 years in the BAT group and 4 years in the NoBAT group. Results In the NoBAT group significant more rectal toxicity occurred, while in GU toxicity no difference was seen. Two patients in the NoBAT group showed late rectal toxicity grade 3, no toxicity > grade 2 occurred in the BAT group. There was no significant difference in PSA reduction between the groups. Conclusion Without BAT significant more acute and a trend to more late rectal toxicity was found. With regard to dose escalation this aspect is currently evaluated with a larger number of patients using intensity-modulated radiotherapy (IMRT). (orig.)

  13. Designing Tracking Software for Image-Guided Surgery Applications: IGSTK Experience.

    Science.gov (United States)

    Enquobahrie, Andinet; Gobbi, David; Turek, Matt; Cheng, Patrick; Yaniv, Ziv; Lindseth, Frank; Cleary, Kevin

    2008-11-01

    OBJECTIVE: Many image-guided surgery applications require tracking devices as part of their core functionality. The Image-Guided Surgery Toolkit (IGSTK) was designed and developed to interface tracking devices with software applications incorporating medical images. METHODS: IGSTK was designed as an open source C++ library that provides the basic components needed for fast prototyping and development of image-guided surgery applications. This library follows a component-based architecture with several components designed for specific sets of image-guided surgery functions. At the core of the toolkit is the tracker component that handles communication between a control computer and navigation device to gather pose measurements of surgical instruments present in the surgical scene. The representations of the tracked instruments are superimposed on anatomical images to provide visual feedback to the clinician during surgical procedures. RESULTS: The initial version of the IGSTK toolkit has been released in the public domain and several trackers are supported. The toolkit and related information are available at www.igstk.org. CONCLUSION: With the increased popularity of minimally invasive procedures in health care, several tracking devices have been developed for medical applications. Designing and implementing high-quality and safe software to handle these different types of trackers in a common framework is a challenging task. It requires establishing key software design principles that emphasize abstraction, extensibility, reusability, fault-tolerance, and portability. IGSTK is an open source library that satisfies these needs for the image-guided surgery community.

  14. An event-driven distributed processing architecture for image-guided cardiac ablation therapy.

    Science.gov (United States)

    Rettmann, M E; Holmes, D R; Cameron, B M; Robb, R A

    2009-08-01

    Medical imaging data is becoming increasing valuable in interventional medicine, not only for preoperative planning, but also for real-time guidance during clinical procedures. Three key components necessary for image-guided intervention are real-time tracking of the surgical instrument, aligning the real-world patient space with image-space, and creating a meaningful display that integrates the tracked instrument and patient data. Issues to consider when developing image-guided intervention systems include the communication scheme, the ability to distribute CPU intensive tasks, and flexibility to allow for new technologies. In this work, we have designed a communication architecture for use in image-guided catheter ablation therapy. Communication between the system components is through a database which contains an event queue and auxiliary data tables. The communication scheme is unique in that each system component is responsible for querying and responding to relevant events from the centralized database queue. An advantage of the architecture is the flexibility to add new system components without affecting existing software code. In addition, the architecture is intrinsically distributed, in that components can run on different CPU boxes, and even different operating systems. We refer to this Framework for Image-Guided Navigation using a Distributed Event-Driven Database in Real-Time as the FINDER architecture. This architecture has been implemented for the specific application of image-guided cardiac ablation therapy. We describe our prototype image-guidance system and demonstrate its functionality by emulating a cardiac ablation procedure with a patient-specific phantom. The proposed architecture, designed to be modular, flexible, and intuitive, is a key step towards our goal of developing a complete system for visualization and targeting in image-guided cardiac ablation procedures.

  15. A Pulsatile Flow Phantom for Image-Guided HIFU Hemostasis of Blood Vessels

    Science.gov (United States)

    Greaby, Robyn; Vaezy, Shahram

    2005-03-01

    A pulsatile flow phantom for studying ultrasound image-guided acoustic hemostasis in a controlled environment has been developed. An ex vivo porcine carotid artery was attached to the phantom and embedded in a visually and ultrasonically transparent gel. Heparinized porcine blood was pumped through the phantom. Power-Doppler and B-mode ultrasound were used to remotely target the HIFU focus to the site of a needle puncture. In nine trials, complete hemostasis was achieved after an average HIFU application of 55 +/- 34 seconds. The vessels remained patent after treatment. With this phantom, it will be possible to do controlled studies of ultrasound image-guided acoustic hemostasis.

  16. Image-Guided Endoscopic Endonasal Transmaxillary Transpterygoid Approach to Meckel's Cave.

    Science.gov (United States)

    Wang, Xuejian; Zhang, Xiaobiao; Hu, Fan; Yu, Yong; Gu, Ye; Xie, Tao; Ge, Junqi

    2016-01-01

    The aim of this report was to summarize our preliminary experience on the resection of tumors located in Meckel's cave via the endoscopic endonasal transmaxillary transpterygoid approach with image-guided system and to investigate the feasibility and efficacy of this approach. Two patients who had tumors in left Meckel's cave underwent surgical treatment using the image-guided endoscopic endonasal transmaxillary transpterygoid approach. This particular technique has advantages of no brain retraction, direct vision of tumor resection and protection of surrounding neurovascular structures. Neuronavigation increases the safety of the endoscopic approach.

  17. From clinical imaging and computational models to personalised medicine and image guided interventions.

    Science.gov (United States)

    Hawkes, David J

    2016-10-01

    This short paper describes the development of the UCL Centre for Medical Image Computing (CMIC) from 2006 to 2016, together with reference to historical developments of the Computational Imaging sciences Group (CISG) at Guy's Hospital. Key early work in automated image registration led to developments in image guided surgery and improved cancer diagnosis and therapy. The work is illustrated with examples from neurosurgery, laparoscopic liver and gastric surgery, diagnosis and treatment of prostate cancer and breast cancer, and image guided radiotherapy for lung cancer.

  18. [History, evolution and application of robotic surgery in urology].

    Science.gov (United States)

    Romero Otero, Javier; Paparel, Philippe; Atreya, Dash; Touijer, Karim; Guillonneau, Bertrand

    2007-05-01

    Robotic is an antique concep. The first robots used in surgery were precise path systems in the 80's. Stereotactic neurosurgery was the first field applying this devices. Based on these more complex devices were built: AESOP and Endoassist help the surgeon during the surgery. The surgical assistant will not fatigue and there will be no tremor of the camera. Finally the master-slave devices were developed. They are the most commenly used all around the world. They are involved many types surgery in. To evaluate the cost-effectiviness of robotics in surgery is our responsability. Robotics provides many advantages but also has a few disadvantages including expense.

  19. Robot maps, robot moves, robot avoids

    OpenAIRE

    Farrugia, Claire

    2014-01-01

    Robotics is a cornerstone for this century’s innovations. From robot nurses to your own personal assistant, most robots need to know: ‘where is it?’ ‘Where should it go?’ And ‘how to get there?’ Without answers to these questions a robot cannot do much. http://www.um.edu.mt/think/robot-maps-robot-moves-robot-avoids/

  20. Robot maps, robot moves, robot avoids

    OpenAIRE

    Farrugia, Claire; Duca, Edward

    2014-01-01

    Robotics is a cornerstone for this century’s innovations. From robot nurses to your own personal assistant, most robots need to know: ‘where is it?’ ‘Where should it go?’ And ‘how to get there?’ Without answers to these questions a robot cannot do much. http://www.um.edu.mt/think/robot-maps-robot-moves-robot-avoids/

  1. Robot Actors, Robot Dramaturgies

    DEFF Research Database (Denmark)

    Jochum, Elizabeth

    This paper considers the use of tele-operated robots in live performance. Robots and performance have long been linked, from the working androids and automata staged in popular exhibitions during the nineteenth century and the robots featured at Cybernetic Serendipity (1968) and the World Expo...

  2. Robot Actors, Robot Dramaturgies

    DEFF Research Database (Denmark)

    Jochum, Elizabeth

    This paper considers the use of tele-operated robots in live performance. Robots and performance have long been linked, from the working androids and automata staged in popular exhibitions during the nineteenth century and the robots featured at Cybernetic Serendipity (1968) and the World Expo...

  3. Robotics in pediatric surgery: perspectives for imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kant, Adrien J.; Klein, Michael D. [Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program, Children' s Research Center of Michigan, Detroit, MI 48201 (United States); Langenburg, Scott E. [Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program, Children' s Research Center of Michigan, Detroit, MI 48201 (United States); Department of Pediatric Surgery, Children' s Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201 (United States)

    2004-06-01

    Robotic surgery will give surgeons the ability to perform essentially tremorless microsurgery in tiny spaces with delicate precision and may enable procedures never before possible on children, neonates, and fetuses. Collaboration with radiologists, engineers, and other scientists will permit refinement of image-guided technologies and allow the realization of truly remarkable concepts in minimally invasive surgery. While robotic surgery is now in clinical use in several surgical specialties (heart bypass, prostate removal, and various gastrointestinal procedures), the greatest promise of robotics lies in pediatric surgery. We will briefly review the history and background of robotic technology in surgery, discuss its present benefits and uses and those being explored, and speculate on the future, with attention to the current and potential involvement of imaging modalities and the role of image guidance. (orig.)

  4. Intra-operative robotics: NeuroArm.

    Science.gov (United States)

    Lang, Michael J; Greer, Alexander D; Sutherland, Garnette R

    2011-01-01

    This manuscript describes the development and ongoing integration of neuroArm, an image-guided MR-compatible robot. A neurosurgical robotics platform was developed, including MR-compatible manipulators, or arms, with seven degrees of freedom, a main system controller, and a human-machine interface. This system was evaluated during pre-clinical trials and subsequent clinical application, combined with intra-operative MRI, at both 1.5 and 3.0 T. An MR-compatible surgical robot was successfully developed and merged with ioMRI at both 1.5 or 3.0 T. Image-guidance accuracy and microsurgical capability were established in pre-clinical trials. Early clinical experience demonstrated feasibility and showed the importance of a master-slave configuration. Surgeon-directed manipulator control improved performance and safety. NeuroArm successfully united the precision and accuracy of robotics with the executive decision-making capability of the surgeon.

  5. Microencapsulation of indocyanine green for potential applications in image-guided drug delivery.

    Science.gov (United States)

    Zhu, Zhiqiang; Si, Ting; Xu, Ronald X

    2015-02-07

    We present a novel process to encapsulate indocyanine green (ICG) in liposomal droplets at high concentration for potential applications in image-guided drug delivery. The microencapsulation process follows two consecutive steps of droplet formation by liquid-driven coaxial flow focusing (LDCFF) and solvent removal by oil phase dewetting. These biocompatible lipid vesicles may have important applications in drug delivery and fluorescence imaging.

  6. Image-guided diagnosis of prostate cancer can increase detection of tumors

    Science.gov (United States)

    In the largest prospective study to date of image-guided technology for identifying suspicious regions of the prostate to biopsy, researchers compared the ability of this technology to detect high-risk prostate cancer with that of the current standard of

  7. Image-Guided Techniques Improve the Short-Term Outcome of Autologous Osteochondral Cartilage Repair Surgeries

    Science.gov (United States)

    Devlin, Steven M.; Hurtig, Mark B.; Waldman, Stephen D.; Rudan, John F.; Bardana, Davide D.; Stewart, A. James

    2013-01-01

    Objective: Autologous osteochondral cartilage repair is a valuable reconstruction option for cartilage defects, but the accuracy to harvest and deliver osteochondral grafts remains problematic. We investigated whether image-guided methods (optically guided and template guided) can improve the outcome of these procedures. Design: Fifteen sheep were operated to create traumatic chondral injuries in each knee. After 4 months, the chondral defect in one knee was repaired using (a) conventional approach, (b) optically guided method, or (c) template-guided method. For both image-guided groups, harvest and delivery sites were preoperatively planned using custom-made software. During optically guided surgery, instrument position and orientation were tracked and superimposed onto the surgical plan. For the template-guided group, plastic templates were manufactured to allow an exact fit between template and the joint anatomy. Cylindrical holes within the template guided surgical tools according to the plan. Three months postsurgery, both knees were harvested and computed tomography scans were used to compare the reconstructed versus the native pre-injury joint surfaces. For each repaired defect, macroscopic (International Cartilage Repair Society [ICRS]) and histological repair (ICRS II) scores were assessed. Results: Three months after repair surgery, both image-guided surgical approaches resulted in significantly better histology scores compared with the conventional approach (improvement by 55%, P < 0.02). Interestingly, there were no significant differences found in cartilage surface reconstruction and macroscopic scores between the image-guided and the conventional surgeries. PMID:26069658

  8. Occipital condyle screw placement and occipitocervical instrumentation using three-dimensional image-guided navigation.

    Science.gov (United States)

    Le, Tien V; Burkett, Clint; Ramos, Edwin; Uribe, Juan S

    2012-05-01

    Occipital condyle (OC) screws are an alternative cephalad fixation point in occipitocervical fusion. Safe placement of occipital, C1 lateral mass, and C2 pars screws have been described previously, but not OC screws. The craniocervical junction is complex, and a thorough understanding of the anatomy is needed. Three-dimensional (3D) image-guided navigation was used in six patients. There were no complications related to image-guided navigation during the placement of 12 OC screws and we found that this navigation can serve as a useful adjunct when placing an OC screw. Technical considerations of placing OC and C1 lateral mass screws are discussed with particular reference to patient positioning and the StealthStation® S7™ image-guided navigational platform (Medtronic, Minneapolis, MN, USA). The reference arc is attached to the head-clamp and faces forward. The optical camera and monitor are positioned at the head of the table for a direct, non-obstructed line-of-sight. To minimize intersegmental movement, the OC should not be drilled until all other screws have been placed. We conclude that 3D image-guided navigation is a useful adjunct that can be safely and effectively used for placement of instrumentation of the upper cervical spine including the OC. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Injectable Colloidal Gold for Use in Intrafractional 2D Image-Guided Radiation Therapy

    DEFF Research Database (Denmark)

    Jølck, Rasmus Irming; Rydhog, Jonas S.; Christensen, Anders Nymark

    2015-01-01

    In the western world, approximately 50% of all cancer patients receive radiotherapy alone or in combination with surgery or chemotherapy. Image-guided radiotherapy (IGRT) has in recent years been introduced to enhance precision of the delivery of radiation dose to tumor tissue. Fiducial markers a...

  10. Image-guided radiotherapy of bladder cancer: bladder volume variation and its relation to margins

    DEFF Research Database (Denmark)

    Muren, Ludvig; Redpath, Anthony Thomas; Lord, Hannah

    2007-01-01

    BACKGROUND AND PURPOSE: To control and account for bladder motion is a major challenge in radiotherapy (RT) of bladder cancer. This study investigates the relation between bladder volume variation and margins in conformal and image-guided RT (IGRT) for this disease. MATERIALS AND METHODS: The cor...

  11. Clinical results of a pilot study on stereovision-guided stereotactic radiotherapy and intensity modulated radiotherapy.

    Science.gov (United States)

    Li, Shidong; Kleinberg, Lawrence R; Rigamonti, Daniele; Wharam, Moody D; Rashid, Abdul; Jackson, Juan; Djajaputra, David; He, Shenjen; Creasey, Tunisia; DeWeese, Theodore L

    2010-12-01

    Real-time stereovision-guidance has been introduced for efficient and convenient fractionated stereotactic radiotherapy (FSR) and image-guided intensity-modulated radiation therapy (IMRT). This first pilot study is to clinically evaluate its accuracy and precision as well as impact on treatment doses. Sixty-one FSR patients wearing stereotactic masks (SMs) and nine IMRT patients wearing flexible masks (FMs), were accrued. Daily target reposition was initially based-on biplane-radiographs and then adjusted in six degrees of freedom under real-time stereovision guidance. Mean and standard deviation of the head displacements measured the accuracy and precision. Head positions during beam-on times were measured with real-time stereovisions and used for determination of delivered doses. Accuracy ± ± precision in direction with the largest errors shows improvement from 0.4 ± 2.3 mm to 0.0 ± 1.0 mm in the inferior-to-superior direction for patients wearing SM or from 0.8 ± 4.3 mm to 0.4 ± 1.7 mm in the posterior-to-anterior direction for patients wearing FM. The image-guidance increases target volume coverage by >30% for small lesions. Over half of head position errors could be removed from the stereovision-guidance. Importantly, the technique allows us to check head position during beam-on time and makes it possible for having frameless head refixation without tight masks.

  12. Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery

    Directory of Open Access Journals (Sweden)

    Michael Joseph LaRiviere

    2016-12-01

    Full Text Available Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular radiofrequency ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT, whose development began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided radiofrequency ablation series for mesial temporal lobe epilepsy. The development of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided laser interstitial thermotherapy systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies.

  13. Patient specific quality control for Stereotactic Ablative Body Radiotherapy (SABR): it takes more than one phantom

    Science.gov (United States)

    Kron, T.; Ungureanu, E.; Antony, R.; Hardcastle, N.; Clements, N.; Ukath, J.; Fox, C.; Lonski, P.; Wanigaratne, D.; Haworth, A.

    2017-01-01

    Stereotactic Ablative Body Radiotherapy (SABR) is an extension of the concepts of Stereotactic Radiosurgery from intracranial procedures to extracranial targets. This brings with it new technological challenges for set-up of a SABR program and continuing quality assurance. Compared with intracranial procedures SABR requires consideration of motion and inhomogeneities and has to deal with a much larger variety of targets ranging from lung to liver, kidney and bone. To meet many of the challenges virtually all advances in modern radiotherapy, such as Intensity Modulated and Image Guided Radiation Therapy (IMRT and IGRT) are used. Considering the few fractions and high doses per fraction delivered to complex targets it is not surprising that patient specific quality control is considered essential for safe delivery. Given the variety of targets and clinical scenarios we employ different strategies for different patients to ensure that the most important aspects of the treatment are appropriately tested, be it steep dose gradients, inhomogeneities or the delivery of dose in the presence of motion. The current paper reviews the different approaches and phantoms utilised at Peter MacCallum Cancer Centre for SABR QA.

  14. Robotic architectures

    CSIR Research Space (South Africa)

    Mtshali, M

    2010-01-01

    Full Text Available In the development of mobile robotic systems, a robotic architecture plays a crucial role in interconnecting all the sub-systems and controlling the system. The design of robotic architectures for mobile autonomous robots is a challenging...

  15. Stereotactic limbic leucotomy: surgical technique

    Science.gov (United States)

    Richardson, Alan

    1973-01-01

    The requirements for modern psychosurgery are safety and accuracy. Stereotactic techniques give the geometric accuracy and stimulation gives physiological information, which is important in determining lesion sites or at least lesion symmetry. The process whereby focal brain destruction is produced is ideally by a freezing probe, but equally effectively by coagulation. A number of small lesions is thus required. This at present is unavoidable if side effects are to be obviated. Careful continuing assessment of results is necessary to validate any surgical procedure. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:4618905

  16. Imaging Advances in Stereotactic Radiosurgery.

    Science.gov (United States)

    Tsien, Christina; Drzymala, Robert E; Rich, Keith

    2015-01-01

    Novel functional and metabolic MRI imaging provides the ability to analyze tumor tissue properties including tumor vasculature, vascular permeability, tumor cellularity, hypoxia, and tumor proliferation. Stereotactic radiosurgery involves the delivery of a very precise, focal dose of radiation to a target. Recent advances in MR imaging have the potential to improve accuracy for target volume delineation and to potentially improve outcome. Novel MR imaging techniques may also be used in subsequent post-treatment follow-up to distinguish between tumor recurrences versus non-neoplastic treatment-related changes. In this paper, we address multiparametric MR imaging and cerebral angiography as tools to reduce toxicity.

  17. Noninvasive stereotactic radiosurgery (CyberHeart) for creation of ablation lesions in the atrium.

    Science.gov (United States)

    Sharma, Arjun; Wong, Douglas; Weidlich, Georg; Fogarty, Thomas; Jack, Alice; Sumanaweera, Thilaka; Maguire, Patrick

    2010-06-01

    A variety of catheter-based energy modalities are used for cardiac ablation to treat arrhythmias. Robotic radiosurgery is increasingly being utilized to successfully accomplish precise tissue ablation in anatomically remote areas. The purpose of this study was to examine the experimental feasibility of a noninvasive method using stereotactic robotic radiosurgery (SRS) to create cardiac lesions. Sixteen (16) Hanford-Sinclair mini swine (weight 40-70 kg) under general anesthesia were studied. Baseline computed tomographic scans were performed, followed by electroanatomic mapping using the CARTO system. Stereotactic robotic radiosurgery was performed using the CyberHeart system, with predetermined targets at the cavotricuspid isthmus, AV node, pulmonary vein-left atrial junction, or left atrial appendage. From 25 to 196 days after treatment, the animals were investigated with repeat electroanatomic voltage mapping and transesophageal echocardiography, when possible. The animals then were sacrificed and pathology specimens taken. Dose ranging suggested that 25 Gy was needed to produce an electrophysiologic effect. The time course showed an electrophysiologic effect consistently by 90 days. The method was feasible for producing bidirectional cavotricuspid isthmus block and AV nodal conduction block. The pulmonary vein-left atrial junction and left atrial appendage showed marked voltage reduction to less than 0.05 mV. No spontaneous arrhythmias were observed. Pathology specimens showed no evidence of radiation damage outside the target. Histology samples from target sites showed effects consistent with X-beam radiation. Stereotactic robotic radiosurgery can produce cavotricuspid isthmus block, AV nodal block, and significant decreased voltage at the pulmonary vein-left atrial junction. No other organ damage was seen. The study findings demonstrate the feasibility of this noninvasive treatment method for creating cardiac lesions. This approach merits further investigation

  18. Stereotactic radiosurgery for intracranial meningiomas

    Energy Technology Data Exchange (ETDEWEB)

    Kida, Yoshihisa; Kobayashi, Tatsuya; Tanaka, Takayuki; Oyama, Hirofumi; Iwakoshi, Takayasu (Komaki City Hospital, Hokkaido (Japan))

    1994-07-01

    Stereotactic radiosurgery for intracranial meningiomas was attempted using a 201-source cobalt gamma knife. Forty patients bearing 42 tumors were involved in this study. Their ages ranged from 30 to 91 years, with an average of 55.1 years. The most frequent sites of origin were the parasellar and petroclival regions. The mean tumor diameter was 27.2 mm and the marginal tumor dose of radiosurgery ranged from 10 to 20 Gy, depending on tumor location and size. Serial imaging studies with MRI were obtained in all 40 cases, in which minor tumor shrinkage was demonstrated in 7.9%, 40.0% and 53.3% at 6, 12 and 18 months after radiosurgery respectively. Only two tumors became enlarged after the treatment. Obvious low signal intensity on MRI, indicating central tumor necrosis, was found in 32% at 12 months and 40% at 18 months. Four large tumors over 40 mm in mean diameter were treated by staged radiosurgery with intervals of 1.5 to 7 months. A similar good response was able to be obtained in all 4 cases, even though they were treated with a marginal dose less than 12 Gy. Symptomatic edema occurred in 5 cases (12.5%) within 12 months and required corticosteroid therapy and hyperosmotic diuresis. In conclusion stereotactic radiosurgery has proved to be an effective and relatively safe method for the treatment of intracranial meningiomas. (author).

  19. Stereotactic imaging in functional neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Hirabayashi, Hidehiro

    2012-07-01

    Background: The birth of stereotactic functional neurosurgery in 1947 was to a great extent dependent on the development of ventriculography. The last decades have witnessed a renaissance of functional stereotactic neurosurgery in the treatment of patients with movement disorders. Initially, these procedures were largely based on the same imaging technique that had been used since the birth of this technique, and that is still used in some centers. The introduction of new imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provided new potentials, but also new challenges for accurate identification and visualisation of the targets in the basal ganglia and the thalamus with an urge to thoroughly evaluate and optimize the stereotactic targeting technique, as well as evaluate accurately in stereotactic space the location and extent of stereotactic Radiofrequency (RF) lesions and the position of deep brain stimulation (DBS) electrodes. Aims: To study the differences between CT and MRI regarding indirect atlas coordinates in thalamic and pallidal procedures and to evaluate and validate visualisation of the pallidum and the subthalamic nucleus in view of direct targeting irrespective of atlas-derived coordinates. Furthermore, to evaluate the contribution of RF parameters on the size of stereotactic lesions, as well as the impact of size and location on clinical outcome. Method: The coordinates in relation to the landmarks of the 3{sup rd} ventricle of the targets in the pallidum and ventrolateral thalamus were compared between CT and MRI in 34 patients. In another 48 patients direct visualization of the pallidum was evaluated and compared to indirect atlas based targeting. The possibility and versatility of visualizing the Subthalamic Nucleus (STN) on short acquisition MRI were evaluated in a multicentre study, and the use of alternative landmarks in identification of the STN was demonstrated in another study. In 46 patients CT and

  20. [Irradiation in stereotactic conditions: prerequisites].

    Science.gov (United States)

    Maingon, P; Lisbona, A

    2014-10-01

    Indications of treatment by stereotactic body radiotherapy are dramatically increasing due to new potential indications. The conditions associated with the treatment delivery are multiple. The first step of the process is crucial. It is related to the validation of the indication proposed during the multidisciplinary meeting as regard the evidence-based proof of the concept. These emerging techniques mainly extracranial stereotactic body irradiation do not benefit from long-term evaluation in terms of efficiency as well as normal tissue late toxicities. Priority should be given to prospective independent clinical trials, validated by an independent scientific committee, performed under a relevant and well dedicated multicentric quality assurance program aiming to improve knowledge and selection of indications. The SFRO is still working with others professionals on the definition of the conditions for the implementation of such treatments and actively collaborates with the authorities to define the appropriate conditions to preserve the quality of the treatment delivery under these specific conditions. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  1. Stereotactic radiosurgery: a "targeted" therapy for cancer

    Institute of Scientific and Technical Information of China (English)

    Ming Zeng; Liang-Fu Han

    2012-01-01

    The developments of medicine always follow innovations in science and technology.In the past decade,such innovations have made cancer-related targeted therapies possible.In general,the term "targeted therapy" has been used in reference to cellular and molecular level oriented therapies.However,improvements in the delivery and planning of traditional radiation therapy have also provided cancer patients more options for "targeted" treatment,notably stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT).In this review,the progress and controversies of SRS and SBRT are discussed to show the role of stereotactic radiation therapy in the ever evolving multidisciplinary care of cancer patients.

  2. Stereotactic breast biopsy: pitfalls and pearls.

    Science.gov (United States)

    Huang, Monica L; Adrada, Beatriz E; Candelaria, Rosalind; Thames, Deborah; Dawson, Debora; Yang, Wei T

    2014-03-01

    Stereotactic breast biopsies have become indispensable and the standard of care for patients in whom screening mammography or tomosynthesis reveals breast lesions suggestive of malignancy. A variety of stereotactic biopsy systems and needle types are now available, which allow more accurate sampling of lesions as well as successful biopsy of lesions in difficult locations in patients of all body habitus. We discuss how to plan, perform, and follow up stereotactic biopsies. Most importantly, we offer suggestions on how to avoid problems and complications and detail how to achieve technical success even in the most challenging cases. Stereotactic biopsy has proven over time to be an accurate and acceptable alternative to surgical biopsy for histopathologic diagnosis of breast abnormalities. Successful performance of this minimally invasive procedure spares women from undergoing potentially deforming and expensive procedures to diagnose breast disease.

  3. Stereotactic body radiotherapy a practical guide

    CERN Document Server

    Gaya, Andrew

    2015-01-01

    Collecting the key information in this burgeoning field into a single volume, this handbook for clinical oncology trainees and consultants covers all of the basic aspects of stereotactic radiotherapy systems and treatment and includes plenty of case studies.

  4. INTER- AND INTRAFRACTION MOTION FOR STEREOTACTIC RADIOSURGERY IN DOGS AND CATS USING A MODIFIED BRAINLAB FRAMELESS STEREOTACTIC MASK SYSTEM.

    Science.gov (United States)

    Dieterich, Sonja; Zwingenberger, Allison; Hansen, Katherine; Pfeiffer, Isabella; Théon, Alain; Kent, Michael S

    2015-01-01

    Precise and accurate patient positioning is necessary when doing stereotactic radiosurgery (SRS) to ensure adequate dosing to the tumor and sparing of normal tissues. This prospective cross-sectional study aimed to assess feasibility of a commercially available modified frameless SRS positioning system for use in veterinary radiotherapy patients with brain tumors. Fifty-one dogs and 12 cats were enrolled. Baseline and verification CT images were acquired. The verification CT images from 32 dogs and five cats had sufficient images for fusion to baseline CT images. A rigid box-based fusion was performed to determine interfraction motion. Forty-eight dogs and 11 cats were assessed for intrafraction motion by cine CT. Seventy percent of dogs and 60% of cats had interfraction 3D vector translational shifts >1 mm, with mean values of 1.9 mm in dogs, and 1.8 mm in cats. In dogs muscle wasting was weakly correlated with translational shifts. The maximum angular interfraction motion observed was 6.3° (roll), 3.5° (pitch), and 3.3° (yaw). There was no correlation between angular interfraction motion and weight, brachycephaly, or muscle wasting. Fifty-seven percent of dogs and 50% of cats had respiration-related intrafraction motion. Of these, 4.5% of dogs and 10% of cats had intrafraction motion >1 mm. This study demonstrates the modified Brainlab system is feasible for SRS in dogs and cats. The smaller cranial size and difference in anatomy increases setup uncertainty in some animals beyond limits usually accepted in SRS. Image-guided positioning is recommended to achieve clinically acceptable setup accuracy (<1 mm) for SRS. © 2015 American College of Veterinary Radiology.

  5. Robot and robot system

    Science.gov (United States)

    Behar, Alberto E. (Inventor); Marzwell, Neville I. (Inventor); Wall, Jonathan N. (Inventor); Poole, Michael D. (Inventor)

    2011-01-01

    A robot and robot system that are capable of functioning in a zero-gravity environment are provided. The robot can include a body having a longitudinal axis and having a control unit and a power source. The robot can include a first leg pair including a first leg and a second leg. Each leg of the first leg pair can be pivotally attached to the body and constrained to pivot in a first leg pair plane that is substantially perpendicular to the longitudinal axis of the body.

  6. MRI anatomical mapping and direct stereotactic targeting in the subthalamic region: functional and anatomical correspondence in Parkinson's disease

    Energy Technology Data Exchange (ETDEWEB)

    Lemaire, Jean-Jacques; Coste, Jerome [CHU Clermont-Ferrand, Hopital Gabriel Montpied, Service de Neurochirurgie A, Clermont-Ferrand (France); Inserm, ERI 14, Clermont-Ferrand (France); Ouchchane, Lemlih [Univ Clermont 1, UFR Medecine, Unite de Bio statistiques, telematique et traitement d' image, Clermont-Ferrand (France); Inserm, ERI 14, Clermont-Ferrand (France); Hemm, Simone [Inserm, ERI 14, Clermont-Ferrand (France); Derost, Philippe; Ulla, Miguel; Durif, Franck [CHU Clermont-Ferrand, Hopital Gabriel Montpied, Service de Neurologie A, Clermont-Ferrand (France); Siadoux, Severine [CHU Clermont-Ferrand, Hopital Gabriel Montpied, Service de Radiologie A, Clermont-Ferrand (France); Gabrillargues, Jean [CHU Clermont-Ferrand, Hopital Gabriel Montpied, Service de Radiologie A, Clermont-Ferrand (France); Inserm, ERI 14, Clermont-Ferrand (France); Chazal, Jean [CHU Clermont-Ferrand, Hopital Gabriel Montpied, Service de Neurochirurgie A, Clermont-Ferrand (France)

    2007-08-15

    Object Relationships between clinical effects, anatomy, and electrophysiology are not fully understood in DBS of the subthalamic region in Parkinson's disease. We proposed an anatomic study based on direct image-guided stereotactic surgery with a multiple source data analysis. Materials and Methods A manual anatomic mapping was realized on coronal 1.5-Tesla MRI of 15 patients. Biological data were collected under local anesthesia: the spontaneous neuron activities and the clinical efficiency and the appearance of adverse effects. They were related to relevant current values (mA), the benefit threshold (bt, minimal current leading an clear efficiency), the adverse effect threshold (at, minimal current leading an adverse effect) and the stimulation margin (sm = at - bt); they were matched with anatomy. Results We found consistent relationships between anatomy and biological data. The optimal stimulation parameters (low bt + high sm) were noted in the dorsolateral STN. The highest spontaneous neuron activity was found in the ventromedial STN. Dorsolateral (sensorimotor) STN seems the main DBS effector. The highest spontaneous neuron activity seems related to the anterior (rostral) ventromedial (limbic) STN. Conclusion 1.5 Tesla images provide sufficiently detailed subthalamic anatomy for image-guided stereotactic surgery and may aid in understanding DBS mechanisms. (orig.)

  7. Interrupting Rivaling Access-flow with Nonsurgical Image-guided ligation: the "IRANI" Procedure.

    Science.gov (United States)

    Cui, Jie; Freed, Robert; Liu, Fengyong; Irani, Zubin

    2015-01-01

    The presence of collateral veins is one of the most common causes of fistula failure to mature. The traditional approach to eliminate collateral vessel flow is coil embolization under fluoroscopy or surgical cut down and branch vessel ligation. However, both approaches are expensive and time consuming. Here, we described an image-guided nonsurgical method to ligate collateral veins. The collateral veins were ligated using Hawkins-Akins needle under ultrasound guidance. The average time for one ligation procedure was 17 minutes. There was a significant increase of blood flow in the venous outflow postligation procedure. Four weeks postprocedure ultrasound demonstrated occlusion of the target vessels. This procedure was well tolerated without major complications. In summary, the novel procedure described here offers an image-guided nonsurgical approach for collateral vein occlusion.

  8. Hard and soft nanoparticles for image-guided surgery in nanomedicine

    Energy Technology Data Exchange (ETDEWEB)

    Locatelli, Erica; Monaco, Ilaria; Comes Franchini, Mauro, E-mail: mauro.comesfranchini@unibo.it [University of Bologn, Department of Industrial Chemistry, “Toso Montanari” (Italy)

    2015-08-15

    The use of hard and/or soft nanoparticles for therapy, collectively called nanomedicine, has great potential in the battle against cancer. Major research efforts are underway in this area leading to development of new drug delivery approaches and imaging techniques. Despite this progress, the vast majority of patients who are affected by cancer today sadly still need surgical intervention, especially in the case of solid tumors. An important perspective for researchers is therefore to provide even more powerful tools to the surgeon for pre- and post-operative approaches. In this context, image-guided surgery, in combination with nanotechnology, opens a new strategy to win this battle. In this perspective, we will analyze and discuss the recent progress with nanoparticles of both metallic and biomaterial composition, and their use to develop powerful systems to be applied in image-guided surgery.

  9. The Image-Guided Surgery ToolKit IGSTK: an open source C++ software toolkit

    Science.gov (United States)

    Cheng, Peng; Ibanez, Luis; Gobbi, David; Gary, Kevin; Aylward, Stephen; Jomier, Julien; Enquobahrie, Andinet; Zhang, Hui; Kim, Hee-su; Blake, M. Brian; Cleary, Kevin

    2007-03-01

    The Image-Guided Surgery Toolkit (IGSTK) is an open source C++ software library that provides the basic components needed to develop image-guided surgery applications. The focus of the toolkit is on robustness using a state machine architecture. This paper presents an overview of the project based on a recent book which can be downloaded from igstk.org. The paper includes an introduction to open source projects, a discussion of our software development process and the best practices that were developed, and an overview of requirements. The paper also presents the architecture framework and main components. This presentation is followed by a discussion of the state machine model that was incorporated and the associated rationale. The paper concludes with an example application.

  10. A novel augmented reality system of image projection for image-guided neurosurgery.

    Science.gov (United States)

    Mahvash, Mehran; Besharati Tabrizi, Leila

    2013-05-01

    Augmented reality systems combine virtual images with a real environment. To design and develop an augmented reality system for image-guided surgery of brain tumors using image projection. A virtual image was created in two ways: (1) MRI-based 3D model of the head matched with the segmented lesion of a patient using MRIcro software (version 1.4, freeware, Chris Rorden) and (2) Digital photograph based model in which the tumor region was drawn using image-editing software. The real environment was simulated with a head phantom. For direct projection of the virtual image to the head phantom, a commercially available video projector (PicoPix 1020, Philips) was used. The position and size of the virtual image was adjusted manually for registration, which was performed using anatomical landmarks and fiducial markers position. An augmented reality system for image-guided neurosurgery using direct image projection has been designed successfully and implemented in first evaluation with promising results. The virtual image could be projected to the head phantom and was registered manually. Accurate registration (mean projection error: 0.3 mm) was performed using anatomical landmarks and fiducial markers position. The direct projection of a virtual image to the patients head, skull, or brain surface in real time is an augmented reality system that can be used for image-guided neurosurgery. In this paper, the first evaluation of the system is presented. The encouraging first visualization results indicate that the presented augmented reality system might be an important enhancement of image-guided neurosurgery.

  11. High contrast optical imaging methods for image guided laser ablation of dental caries lesions

    OpenAIRE

    LaMantia, Nicole R.; Tom, Henry; Chan, Kenneth H.; Simon, Jacob C.; Darling, Cynthia L.; Fried, Daniel

    2014-01-01

    Laser based methods are well suited for automation and can be used to selectively remove dental caries to minimize the loss of healthy tissues and render the underlying enamel more resistant to acid dissolution. The purpose of this study was to determine which imaging methods are best suited for image-guided ablation of natural non-cavitated carious lesions on occlusal surfaces. Multiple caries imaging methods were compared including near-IR and visible reflectance and quantitative light fluo...

  12. Spatially varying Riemannian elasticity regularization: Application to thoracic CT registration in image-guided radiotherapy

    DEFF Research Database (Denmark)

    Bjerre, Troels; Hansen, Mads Fogtmann; Aznar, M.;

    2012-01-01

    For deformable registration of computed tomography (CT) scans in image guided radiation therapy (IGRT) we apply Riemannian elasticity regularization. We explore the use of spatially varying elasticity parameters to encourage bone rigidity and local tissue volume change only in the gross tumor......-model we achieved a total mean target registration error (TRE) of 0.92 ± 0.49 mm. Using spatially varying regularization for the HL case, deformation was limited to the GTV and lungs....

  13. Polydopamine Nanoparticles as a Versatile Molecular Loading Platform to Enable Imaging-guided Cancer Combination Therapy

    OpenAIRE

    Dong, Ziliang; Gong, Hua; Gao, Min; Zhu, Wenwen; Sun, Xiaoqi; Feng, Liangzhu; Fu, Tingting; Li, Yonggang; Liu, Zhuang

    2016-01-01

    Cancer combination therapy to treat tumors with different therapeutic approaches can efficiently improve treatment efficacy and reduce side effects. Herein, we develop a theranostic nano-platform based on polydopamine (PDA) nanoparticles, which then are exploited as a versatile carrier to allow simultaneous loading of indocyanine green (ICG), doxorubicin (DOX) and manganese ions (PDA-ICG-PEG/DOX(Mn)), to enable imaging-guided chemo & photothermal cancer therapy. In this system, ICG acts as a ...

  14. Fabrication of multifaceted, micropatterned surfaces and image-guided patterning using laser scanning lithography.

    Science.gov (United States)

    Slater, John H; West, Jennifer L

    2014-01-01

    This protocol describes the implementation of laser scanning lithography (LSL) for the fabrication of multifaceted, patterned surfaces and for image-guided patterning. This photothermal-based patterning technique allows for selective removal of desired regions of an alkanethiol self-assembled monolayer on a metal film through raster scanning a focused 532 nm laser using a commercially available laser scanning confocal microscope. Unlike traditional photolithography methods, this technique does not require the use of a physical master and instead utilizes digital "virtual masks" that can be modified "on the fly" allowing for quick pattern modifications. The process to create multifaceted, micropatterned surfaces, surfaces that display pattern arrays of multiple biomolecules with each molecule confined to its own array, is described in detail. The generation of pattern configurations from user-chosen images, image-guided LSL is also described. This protocol outlines LSL in four basic sections. The first section details substrate preparation and includes cleaning of glass coverslips, metal deposition, and alkanethiol functionalization. The second section describes two ways to define pattern configurations, the first through manual input of pattern coordinates and dimensions using Zeiss AIM software and the second via image-guided pattern generation using a custom-written MATLAB script. The third section describes the details of the patterning procedure and postpatterning functionalization with an alkanethiol, protein, and both, and the fourth section covers cell seeding and culture. We end with a general discussion concerning the pitfalls of LSL and present potential improvements that can be made to the technique.

  15. Advantages of using an image-guided system for transnasal endoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    韩德民; 周兵; 葛文彤; 张罗; 张永杰

    2003-01-01

    Objective To evaluate the advantages of image-guided system in transnasal endoscopic surgery.Methods Transnasal endoscopic surgery was performed with the aid of an image-guided system in 28 patients, supported with histopathologic diagnoses of chronic sinusitis with/without nasal polyps (10 cases), juvenile nasopharyngeal angiofibroma (4 cases), pituitary adenoma (6 cases), ethmoidal ossifying fibroma (3 cases), nasopharyngeal mixed tumor (2 cases), nasal leiomyoma (1 case), fungal sinusitis (1 case) and inverted nasal papilloma (1 case).Results For all the patients, the time periods from initialization to surgery ranged from 15 to 30 minutes (a mean of 26 minutes). The calibration coefficient ranged from 1.3 to 2.0. Accuracy of localization fell within 1 mm. Compared with traditional endoscopic surgery, operation times were not noticeably different. No complications occurred.Conclusions The image-guided system was able to identify borders and critical anatomical structures in real-time, especially of those with distorted anatomical markers. It provided a powerful means for a safer and less invasive endoscopic sinus surgery.

  16. Parameters Affecting Image-guided, Hydrodynamic Gene Delivery to Swine Liver

    Directory of Open Access Journals (Sweden)

    Kenya Kamimura

    2013-01-01

    Full Text Available Development of a safe and effective method for gene delivery to hepatocytes is a critical step toward gene therapy for liver diseases. Here, we assessed the parameters for gene delivery to the livers of large animals (pigs, 40–65 kg using an image-guided hydrodynamics-based procedure that involves image-guided catheter insertion into the lobular hepatic vein and hydrodynamic injection of reporter plasmids using a computer-controlled injector. We demonstrated that injection parameters (relative position of the catheter in the hepatic vasculature, intravascular pressure upon injection, and injection volume are directly related to the safety and efficiency of the procedure. By optimizing these parameters, we explored for the first time, the advantage of the procedure for sequential injections to multiple lobes in human-sized pigs. The optimized procedure resulted in sustained expression of the human α-1 antitrypsin gene in livers for more than 2 months after gene delivery. In addition, repeated hydrodynamic gene delivery was safely conducted and no adverse events were seen in the entire period of the study. Our results support the clinical applicability of the image-guided hydrodynamic gene delivery method for the treatment of liver diseases.

  17. Polydopamine Nanoparticles as a Versatile Molecular Loading Platform to Enable Imaging-guided Cancer Combination Therapy.

    Science.gov (United States)

    Dong, Ziliang; Gong, Hua; Gao, Min; Zhu, Wenwen; Sun, Xiaoqi; Feng, Liangzhu; Fu, Tingting; Li, Yonggang; Liu, Zhuang

    2016-01-01

    Cancer combination therapy to treat tumors with different therapeutic approaches can efficiently improve treatment efficacy and reduce side effects. Herein, we develop a theranostic nano-platform based on polydopamine (PDA) nanoparticles, which then are exploited as a versatile carrier to allow simultaneous loading of indocyanine green (ICG), doxorubicin (DOX) and manganese ions (PDA-ICG-PEG/DOX(Mn)), to enable imaging-guided chemo & photothermal cancer therapy. In this system, ICG acts as a photothermal agent, which shows red-shifted near-infrared (NIR) absorbance and enhanced photostability compared with free ICG. DOX, a model chemotherapy drug, is then loaded onto the surface of PDA-ICG-PEG with high efficiency. With Mn(2+) ions intrinsically chelated, PDA-ICG-PEG/DOX(Mn) is able to offer contrast under T1-weighted magnetic resonance (MR) imaging. In a mouse tumor model, the MR imaging-guided combined chemo- & photothermal therapy achieves a remarkable synergistic therapeutic effect compared with the respective single treatment modality. This work demonstrates that PDA nanoparticles could serve as a versatile molecular loading platform for MR imaging guided combined chemo- & photothermal therapy with minimal side effects, showing great potential for cancer theranostics.

  18. MR-compatible laparoscope with a distally mounted CCD for MR image-guided surgery

    Energy Technology Data Exchange (ETDEWEB)

    Yasunaga, Takefumi; Konishi, Kozo; Yamaguchi, Shohei; Okazaki, Ken; Hong, Jae-sung; Nakashima, Hideaki [Kyushu University, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Fukuoka (Japan); Ieiri, Satoshi; Tanoue, Kazuo [Kyushu University Hospital, Department of Advanced Medicine and Innovative Technology, Fukuoka (Japan); Fukuyo, Tsuneo [Shinko Optical Co. Ltd, Bunkyo-ku, Tokyo (Japan); Hashizume, Makoto [Kyushu University, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Fukuoka (Japan); Kyushu University Hospital, Department of Advanced Medicine and Innovative Technology, Fukuoka (Japan)

    2007-06-15

    Objects We have developed a new MR-compatible laparoscope that incorporates a distally mounted charge-coupled device (CCD). The MR-compatibility and feasibility of laparoscopy using the new laparoscope were evaluated during MR image-guided laparoscopic radiofrequency ablation therapy (RFA). Materials and methods MR compatibility of the laparoscope was investigated in terms of MR image artifact caused by electromagnetic interference (EMI) and susceptibility. MR images were obtained using spin echo and gradient echo pulse sequences with a 0.3 T open MRI unit. We performed an in vivo experiment with MR image-guided laparoscopic RFA on three pigs; near real-time MR images and 3-D navigation were possible using intraoperative MR images. Agarose gel was injected into the pigs' livers as puncture targets; the diameter of each target was approximately 20 mm. Results Artifacts resulting from EMI were not found in phantom experiments. MR image-guided laparoscopic RFA was successfully performed in all procedures. Both the laparoscopic vision and near real-time MR images were clear. No artifact was detected on the MR images and the surgeon was able to confirm the true position of the probe and target during treatment using the near real-time MR images. Conclusion Laparoscopic surgery is feasible under intraoperative MR image-guidance using a newly developed MR-compatible laparoscope with a distally mounted CCD. (orig.)

  19. Stereotactic Radiosurgery (SRS and Stereotactic Body Radiation Therapy (SBRT Cost-Effectiveness Results

    Directory of Open Access Journals (Sweden)

    Akash eBijlani

    2013-04-01

    Full Text Available Objective: To describe and synthesize the current stereotactic radiosurgery (SRS and stereotactic body radiation therapy (SBRT cost-effectiveness research to date across several common SRS and SBRT applications. Methods: This review was limited to comparative economic evaluations of SRS, SBRT and alternative treatments (e.g., other radiotherapy techniques or surgery. Based on PubMed searches using the terms, stereotactic, stereotactic radiosurgery, stereotactic radiotherapy, stereotactic body radiotherapy, stereotactic body radiation therapy, stereotactic ablative radiotherapy, economic evaluation, quality adjusted life year (QALY, cost, cost effectiveness, cost utility and cost analysis, published studies of cost-effectiveness and health economics were obtained. Included were articles in peer-reviewed journals that presented a comparison of costs between treatment alternatives from January 1997 to November 2012. Papers were excluded if they did not present cost calculations, therapeutic cost comparisons, or health economic endpoints. Results: Clinical outcomes and costs of SRS and SBRT were compared to other therapies for treatment of cancer in the brain, spine, lung, prostate and pancreas. Treatment outcomes for SRS and SBRT are usually superior or comparable, and cost-effective, relative to alternative techniques. Conclusion: Based on the review of current SRS and SBRT clinical and health economic literature, from a patient perspective, SRS and SBRT provide patients a clinically-effective treatment option, while from the payer and provider perspective, SRS and SBRT demonstrate cost-savings.

  20. SU-E-J-53: A Phantom Design to Assist Patient Position Verification System in Daily Image-Guided RT and Comprehensive QA Measurements

    Energy Technology Data Exchange (ETDEWEB)

    Syh, J; Wu, H [Willis-Knighton Medical Center, Shreveport, LA (United States)

    2015-06-15

    Purpose This study is to implement a homemade novel device with surface locking couch index to check daily radiograph (DR) function of adaPTInsight™, stereoscopic image guided system (SIGS), for proton therapy. The comprehensive daily QA checks of proton pencil beam output, field size, flatness and symmetry of spots and energy layers will be followed by using MatriXX dosimetry device. Methods The iBa MatriXX device was used to perform daily dosimetry which is also used to perform SIGS checks. A set of markers were attached to surface of MatriXX device in alignment of DRR of reconstructed CT images and daily DR. The novel device allows MatriXX to be fit into the cradle which was locked by couch index bars on couch surface. This will keep the MatriXX at same XY plane daily with exact coordinates. Couch height Z will be adjusted according to imaging to check isocenter-laser coincidence accuracy. Results adaPTInsight™ provides robotic couch to move in 6-degree coordinate system to align the dosimetry device to be within 1.0 mm / 1.0°. The daily constancy was tightened to be ± 0.5 mm / 0.3° compared to 1.0 mm / 1.0° before. For gantry at 0° and couch all 0° angles (@ Rt ARM 0 setting), offsets measured of the couch systems were ≤ 0.5° in roll, yaw and pitch dimensions. Conclusion Simplicity of novel device made daily image guided QA consistent with accuracy. The offset of the MatriXX isocenter-laser coincident was reproducible. Such easy task not only speeds up the setup, but it increases confidence level in detailed daily comprehensive measurements. The total SIGS alignment time has been shortened with less setup error. This device will enhance our experiences for the future QA when cone beam CT imaging modality becomes available at proton therapy center.

  1. Robotic Radiosurgery. Treating prostata cancer and related genitourinary applications

    Energy Technology Data Exchange (ETDEWEB)

    Ponsky, Lee E. (ed.) [Case Western Reserve University School of Medicine, Cleveland, OH (United States). University Hospitals Case Medical Center

    2012-07-01

    Prostate cancer is the most common cancer among North American and European men, but its treatment continues to be problematic owing to serious side-effects, including erectile dysfunction, urinary incontinence, and potential lower GI complications. Robotic radiosurgery offers a novel, rapid, non-invasive outpatient treatment option for prostate cancer that combines robotics, advanced image-guided motion detection, and automated real-time corrective spatial positioning with submillimeter precision. This book examines all aspects of the treatment of prostate cancer with robotic radiosurgery. After introductory sections on radiosurgery as a multidisciplinary practice and specific issues relating to prostate cancer, the important challenge posed by prostate motion when administering radiation therapy is examined in depth, with detailed discussion as to how image-guided robotic radiosurgery overcomes this problem by continously identifying the precise location of the prostate throughout the course of treatment. A further major section is devoted to a discussion of techniques and potential radiobiological and clinical advantages of hypofractionated radiation delivery by means of robotic radiosurgery systems. The book closes by discussing other emerging genitourinary applications of robotic radiosurgery. All of the authors are experts in their field who present a persuasive case for this fascinating technique. (orig.)

  2. [Clinical experience in image-guided ultra-conformal hypofractionated radiotherapy in case of metastatic diseases at the University of Pécs].

    Science.gov (United States)

    László, Zoltán; Boronkai, Árpád; Lõcsei, Zoltán; Kalincsák, Judit; Szappanos, Szabolcs; Farkas, Róbert; Al Farhat, Yousuf; Sebestyén, Zsolt; Sebestyén, Klára; Kovács, Péter; Csapó, László; Mangel, László

    2015-06-01

    With the development of radiation therapy technology, the utilization of more accurate patient fixation, inclusion of PET/CT image fusion into treatment planning, 3D image-guided radiotherapy, and intensity-modulated dynamic arc irradiation, the application of hypofractionated stereotactic radiotherapy can be extended to specified extracranial target volumes, and so even to the treatment of various metastases. Between October 2012 and August 2014 in our institute we performed extracranial, hypofractionated, image-többguided radiotherapy with RapidArc system for six cases, and 3D conformal multifield technique for one patient with Novalis TX system in case of different few-numbered and slow-growing metastases. For the precise definition of the target volumes we employed PET/CT during the treatment planning procedure. Octreotid scan was applied in one carcinoid tumour patient. Considering the localisation of the metastases and the predictable motion of the organs, we applied 5 to 20 mm safety margin during the contouring procedure. The average treatment volume was 312 cm3. With 2.5-3 Gy fraction doses we delivered 39-45 Gy total dose, and the treatment duration was 2.5 to 3 weeks. The image guidance was carried out via ExacTrac, and kV-Cone Beam CT equipment based on an online protocol, therefore localisation differences were corrected before every single treatment. The patients tolerated the treatments well without major (Gr>2) side effects. Total or near total regression of the metastases was observed at subsequent control examinations in all cases (the median follow-up time was 5 months). According to our first experience, extracranial, imageguided hypofractionated radiotherapy is well-tolerated by patients and can be effectively applied in the treatment of slow-growing and few-numbered metastases.

  3. Stereotactic computer tomography with a modified Riechert-Mundinger device as the basis for integrated stereotactic neuroradiological investigations

    Energy Technology Data Exchange (ETDEWEB)

    Sturm, V.; Pastyr, O.; Schlegel, W.; Scharfenberg, H.; Zabel, H.J.; Netzeband, G.; Schabbert, S.; Berberich, W. (Heidelberg Univ. (Germany, F.R.))

    1983-01-01

    For stereotactic biopsy, intracavitary and interstitial irradiation of intracranial tumours, stereotactic CT investigations are of utmost importance. Targetpoints within a tumour as well as the tumour-outlines have to be transferred precisely from transverse and longitudinal CT sections to stereotactic X-ray images. For this purpose, the stereotactic apparatus of Riechert and Mundinger has been equipped with a fixation system of carbon fibre and a measuring phantoma of plexiglas with embedded steel wires allowing stereotactic CT scanning without artefacts. The stereotactic coordinates (x, y, z) of any target point can be taken directly from transverse CT images with high accuracy. The tumour outlines can be transferred to the stereotactic coordinate system from longitudinal CT reconstructions using special programmes. Precise transfer is possible if the CT investigations are performed stereotactically.

  4. MO-DE-210-03: Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities

    Energy Technology Data Exchange (ETDEWEB)

    Ding, K. [Johns Hopkins University: Development of Intra-Fraction Soft Tissue Monitoring with Ultrasound Imaging (United States)

    2015-06-15

    Ultrasound imaging is an attractive method for image guided radiation treatment (IGRT), by itself or to complement other imaging modalities. It is inexpensive, portable and provides good soft tissue contrast. For challenging soft tissue targets such as pancreatic cancer, ultrasound imaging can be used in combination with pre-treatment MRI and/or CT to transfer important anatomical features for target localization at time of treatment. The non-invasive and non-ionizing nature of ultrasound imaging is particularly powerful for intra-fraction localization and monitoring. Recognizing these advantages, efforts are being made to incorporate novel robotic approaches to position and manipulate the ultrasound probe during irradiation. These recent enabling developments hold potential to bring ultrasound imaging to a new level of IGRT applications. However, many challenges, not limited to image registration, robotic deployment, probe interference and image acquisition rate, need to be addressed to realize the full potential of IGRT with ultrasound imaging. Learning Objectives: Understand the benefits and limitations in using ultrasound to augment MRI and/or CT for motion monitoring during radiation therapy delivery. Understanding passive and active robotic approaches to implement ultrasound imaging for intra-fraction monitoring. Understand issues of probe interference with radiotherapy treatment. Understand the critical clinical workflow for effective and reproducible IGRT using ultrasound guidance. The work of X.L. is supported in part by Elekta; J.W. and K.D. is supported in part by a NIH grant R01 CA161613 and by Elekta; D.H. is support in part by a NIH grant R41 CA174089.

  5. Value of MR contrast media in image-guided body interventions.

    Science.gov (United States)

    Saeed, Maythem; Wilson, Mark

    2012-01-28

    In the past few years, there have been multiple advances in magnetic resonance (MR) instrumentation, in vivo devices, real-time imaging sequences and interventional procedures with new therapies. More recently, interventionists have started to use minimally invasive image-guided procedures and local therapies, which reduce the pain from conventional surgery and increase drug effectiveness, respectively. Local therapy also reduces the systemic dose and eliminates the toxic side effects of some drugs to other organs. The success of MR-guided procedures depends on visualization of the targets in 3D and precise deployment of ablation catheters, local therapies and devices. MR contrast media provide a wealth of tissue contrast and allows 3D and 4D image acquisitions. After the development of fast imaging sequences, the clinical applications of MR contrast media have been substantially expanded to include pre- during- and post-interventions. Prior to intervention, MR contrast media have the potential to localize and delineate pathologic tissues of vital organs, such as the brain, heart, breast, kidney, prostate, liver and uterus. They also offer other options such as labeling therapeutic agents or cells. During intervention, these agents have the capability to map blood vessels and enhance the contrast between the endovascular guidewire/catheters/devices, blood and tissues as well as direct therapies to the target. Furthermore, labeling therapeutic agents or cells aids in visualizing their delivery sites and tracking their tissue distribution. After intervention, MR contrast media have been used for assessing the efficacy of ablation and therapies. It should be noted that most image-guided procedures are under preclinical research and development. It can be concluded that MR contrast media have great value in preclinical and some clinical interventional procedures. Future applications of MR contrast media in image-guided procedures depend on their safety, tolerability

  6. Optimization of an Image-Guided Laser-Induced Choroidal Neovascularization Model in Mice.

    Directory of Open Access Journals (Sweden)

    Yan Gong

    Full Text Available The mouse model of laser-induced choroidal neovascularization (CNV has been used in studies of the exudative form of age-related macular degeneration using both the conventional slit lamp and a new image-guided laser system. A standardized protocol is needed for consistent results using this model, which has been lacking. We optimized details of laser-induced CNV using the image-guided laser photocoagulation system. Four lesions with similar size were consistently applied per eye at approximately double the disc diameter away from the optic nerve, using different laser power levels, and mice of various ages and genders. After 7 days, the mice were sacrificed and retinal pigment epithelium/choroid/sclera was flat-mounted, stained with Isolectin B4, and imaged. Quantification of the area of the laser-induced lesions was performed using an established and constant threshold. Exclusion criteria are described that were necessary for reliable data analysis of the laser-induced CNV lesions. The CNV lesion area was proportional to the laser power levels. Mice at 12-16 weeks of age developed more severe CNV than those at 6-8 weeks of age, and the gender difference was only significant in mice at 12-16 weeks of age, but not in those at 6-8 weeks of age. Dietary intake of omega-3 long-chain polyunsaturated fatty acid reduced laser-induced CNV in mice. Taken together, laser-induced CNV lesions can be easily and consistently applied using the image-guided laser platform. Mice at 6-8 weeks of age are ideal for the laser-induced CNV model.

  7. An image-guided precision proton radiation platform for preclinical in vivo research

    Science.gov (United States)

    Ford, E.; Emery, R.; Huff, D.; Narayanan, M.; Schwartz, J.; Cao, N.; Meyer, J.; Rengan, R.; Zeng, J.; Sandison, G.; Laramore, G.; Mayr, N.

    2017-01-01

    There are many unknowns in the radiobiology of proton beams and other particle beams. We describe the development and testing of an image-guided low-energy proton system optimized for radiobiological research applications. A 50 MeV proton beam from an existing cyclotron was modified to produce collimated beams (as small as 2 mm in diameter). Ionization chamber and radiochromic film measurements were performed and benchmarked with Monte Carlo simulations (TOPAS). The proton beam was aligned with a commercially-available CT image-guided x-ray irradiator device (SARRP, Xstrahl Inc.). To examine the alternative possibility of adapting a clinical proton therapy system, we performed Monte Carlo simulations of a range-shifted 100 MeV clinical beam. The proton beam exhibits a pristine Bragg Peak at a depth of 21 mm in water with a dose rate of 8.4 Gy min‑1 (3 mm depth). The energy of the incident beam can be modulated to lower energies while preserving the Bragg peak. The LET was: 2.0 keV µm‑1 (water surface), 16 keV µm‑1 (Bragg peak), 27 keV µm‑1 (10% peak dose). Alignment of the proton beam with the SARRP system isocenter was measured at 0.24 mm agreement. The width of the beam changes very little with depth. Monte Carlo-based calculations of dose using the CT image data set as input demonstrate in vivo use. Monte Carlo simulations of the modulated 100 MeV clinical proton beam show a significantly reduced Bragg peak. We demonstrate the feasibility of a proton beam integrated with a commercial x-ray image-guidance system for preclinical in vivo studies. To our knowledge this is the first description of an experimental image-guided proton beam for preclinical radiobiology research. It will enable in vivo investigations of radiobiological effects in proton beams.

  8. Safety of an intercostal approach for imaging-guided percutaneous drainage of subdiaphragmatic abscesses.

    Science.gov (United States)

    Preece, Stephen R; Nelson, Rendon C; Bashir, Mustafa R; Jaffe, Tracy A; Kim, Charles Y; Haystead, Clare M

    2014-06-01

    The objective of our study was to test the hypothesis that an intercostal approach to imaging-guided percutaneous subdiaphragmatic abscess drainage is as safe as a subcostal approach. A cohort of 258 consecutive patients with one or more subdiaphragmatic abscesses referred for imaging-guided (CT or ultrasound) percutaneous drainage was identified. Demographic characteristics and clinical outcomes were compared between patients who underwent drainage catheter placement via an intercostal approach versus those who underwent drainage catheter placement via a subcostal approach. Percutaneous drainage was performed for 441 abscesses in 258 patients in 409 separate procedures (214 via an intercostal approach, 186 by a subcostal approach, and nine by a combined approach). The total number of pleural complications was significantly higher in the intercostal group (56/214 [26.2%]) than the subcostal group (15/186 [8.1%]; p intercostal group than the subcostal group (15/214 [7.0%] vs 0/186 [0%], respectively; p intercostal vs subcostal, 3/214 [1.4%] vs 1/186 [0.5%]; p = 0.63). A few of the complications in the patients who underwent an intercostal-approach drainage were clinically significant. Four of the 15 pneumothoraces required thoracostomy tubes and eight of 38 (21.1%) pleural effusions required thoracentesis, none of which was considered infected. An intercostal approach for imaging-guided percutaneous drainage is associated with a higher risk of pleural complications; however, most of these complications are minor and should not preclude use of the intercostal approach.

  9. Development of an MRI-compatible needle insertion manipulator for stereotactic neurosurgery.

    Science.gov (United States)

    Masamune, K; Kobayashi, E; Masutani, Y; Suzuki, M; Dohi, T; Iseki, H; Takakura, K

    1995-01-01

    A variety of medical robots for stereotactic neurosurgery has been developed in recent years. Almost of all these robots use computed tomography (CT) to scan the brain of the patient before and during surgery. Currently, we are developing a needle insertion manipulator for magnetic resonance imaging (MRI)-guided neurosurgery. MRI techniques, including MRI angiography and functional MRI, are attractive for the development of interventional MRI therapies and operations. If a robot were available, these therapies would be minimally invasive, with more accurate guidance than is possible with current CT-guided systems. Actuation of a robot in an MRI environment is difficult because of the presence of strong magnetic fields. Therefore, the robot must be constructed of nonmagnetic materials. The system frame was manufactured using polyethylene terephthalate (PET) and was actuated using ultrasonic motors. Accuracy-evaluation procedures and phantom tests have been performed. The total accuracy of the system was approximately 3.0 mm. No artifacts caused by the manipulator were observed in the images.

  10. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

    LENUS (Irish Health Repository)

    Moran, Deirdre E

    2012-09-01

    Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.

  11. Image-guided high-dose-rate brachytherapy in inoperable endometrial cancer

    Science.gov (United States)

    Petsuksiri, J; Chansilpa, Y; Hoskin, P J

    2014-01-01

    Inoperable endometrial cancer may be treated with curative aim using radical radiotherapy alone. The radiation techniques are external beam radiotherapy (EBRT) alone, EBRT plus brachytherapy and brachytherapy alone. Recently, high-dose-rate brachytherapy has been used instead of low-dose-rate brachytherapy. Image-guided brachytherapy enables sufficient coverage of tumour and reduction of dose to the organs at risk, thus increasing the therapeutic ratio of treatment. Local control rates with three-dimensional brachytherapy appear better than with conventional techniques (about 90–100% and 70–90%, respectively). PMID:24807067

  12. Image-Guided Hydrodynamic Gene Delivery: Current Status and Future Directions

    Directory of Open Access Journals (Sweden)

    Kenya Kamimura

    2015-08-01

    Full Text Available Hydrodynamics-based delivery has been used as an experimental tool to express transgene in small animals. This in vivo gene transfer method is useful for functional analysis of genetic elements, therapeutic effect of oligonucleotides, and cancer cells to establish the metastatic cancer animal model for experimental research. Recent progress in the development of image-guided procedure for hydrodynamics-based gene delivery in large animals directly supports the clinical applicability of this technique. This review summarizes the current status and recent progress in the development of hydrodynamics-based gene delivery and discusses the future directions for its clinical application.

  13. Extensive endoscopic image-guided sinus surgery decreases BPI-ANCA in patients with cystic fibrosis

    DEFF Research Database (Denmark)

    Aanaes, K; Rasmussen, N; Pressler, T

    2012-01-01

    of BPI-ANCA may be due to the costimulation of BPI when mounting an immune response against P. aeruginosa. The effect of surgery aiming to eradicate bacteria and infected tissue on BPI-ANCA levels is sparsely described. A cohort of patients with CF were included: 53 patients having extensive image......-guided sinus surgery (EIGSS) with topical postoperative antibiotic treatment, 131 non-operated controls and 36 who had double lung transplantation (LTX). In all 219 patients, serum samples before and after surgery or at similar intervals were analysed for IgG and IgA BPI-ANCA. The EIGSS group showed a highly...

  14. [The processing of point clouds for brain deformation existing in image guided neurosurgery system].

    Science.gov (United States)

    Yao, Xufeng; Lin, Yixun; Song, Zhijian

    2008-08-01

    The finite element method (FEM) plays an important role in solving the brain deformation problem in the image guided neurosurgery system. The position of the brain cortex during the surgery provides the boundary condition for the FEM model. In this paper, the information of brain cortex is represented by the unstructured points and the boundary condition is achieved by the processing of unstructured points. The processing includes the mapping of texture, segmentation, simplification and denoising. The method of k-nearest clustering based on local surface properties is used to simplify and denoise the unstructured point clouds. The results of experiment prove the efficiency of point clouds processing.

  15. Image-guided endoscopic spine surgery: Part I. A feasibility study.

    Science.gov (United States)

    Assaker, R; Cinquin, P; Cotten, A; Lejeune, J P

    2001-08-01

    A feasibility study was performed to determine the efficacy of computer assistance in endoscopic spine surgery. To assess a new method for computer assistance based on image guidance during thoracoscopic or any endoscopic spine procedure. To evaluate the reproducibility, the sensitivity and the reliability of the technique first in vitro and second in clinical use. The computer-based, image-guided surgery is now a routine tool used in open spine surgery. Exposure of the anatomy of the vertebra is needed for registration. This methodology is inapplicable in endoscopic approach. Fluoroscopic-based navigation combines the technology of image-guided surgery and C-arm fluoroscopy. The navigation is based on the fluoroscopic images acquired before surgery. This technology is applicable to endoscopic surgery but the navigation is based on fluoroscopic image. The computed tomography images are not exploited. There are no published data on a technique that allows image-guided surgery based on computed tomography and magnetic resonance imaging. A laboratory study was performed on a thoracic human spine. One vertebra was marked on the right lateral side of the body with five titanium marks. A percutaneous reference frame was specifically designed to be placed in the pedicle of the same marked vertebrae. The reference frame acted as a 3D localizer and a registration tool. The spine model was scanned including the reference frame. A standard Stealth station treatment guidance platform (Medtronic, Sofamor Danek, Memphis, TN) was used for simulation. The registration was obtained using the reference frame. Twenty navigation procedure trials were done and the error was recorded based on the distance between the anatomical point and the corresponding virtual one. Registration was always possible using the stealth station and a standard spine navigational software (spine 3, Medtronic Sofamor Danek, Memphis, TN). The mean error after registration given by the computer was 0.96 mm

  16. Robot Aesthetics

    DEFF Research Database (Denmark)

    Jochum, Elizabeth Ann; Putnam, Lance Jonathan

    This paper considers art-based research practice in robotics through a discussion of our course and relevant research projects in autonomous art. The undergraduate course integrates basic concepts of computer science, robotic art, live performance and aesthetic theory. Through practice...... in robotics research (such as aesthetics, culture and perception), we believe robot aesthetics is an important area for research in contemporary aesthetics....

  17. A Prospective Cohort Evaluation of a Robotic, Auto-Navigating Operating Microscope

    Science.gov (United States)

    Bohl, Michael A; Oppenlander, Mark E

    2016-01-01

    The unique challenges inherent to microneurosurgery demand that we stay on the forefront of new surgical technologies. Many believe the next major technological advance in neurosurgery will be the widespread application of image-guided robotics in the operating room. We evaluated a novel technology for image-guided robotic auto-navigation of the operating microscope in a prospectively enrolled cohort of patients. Twenty patients were prospectively enrolled for analysis. Data were collected on the extent of resection, operative time, estimated blood loss, time taken to set up the new software, and complications encountered. Software accuracy, reliability, and usefulness in the case were subjectively evaluated. The most commonly  treated pathologies were cavernous malformation (n = 5), arteriovenous malformation (n = 4), and meningioma (n = 4). The time to set up the new software interface before the start of the operation was robotic interface to be accurate, reliable, and useful. The new technology was significantly more useful in deeper lesions. The addition of image-guided robotic auto-positioning features to the operating microscope has a great potential to advance the field of neurosurgery. This study is the first prospective evaluation of such a technology in a patient cohort. The results suggest that the newest robotic auto-positioning technology has the potential to improve the neurosurgeon's efficiency and efficacy, thereby positively impacting patient safety and surgical outcomes, especially in cases involving deep-seated lesions. PMID:27493844

  18. Robotic Architectures

    Directory of Open Access Journals (Sweden)

    Mbali Mtshali

    2010-01-01

    Full Text Available In the development of mobile robotic systems, a robotic architecture plays a crucial role in interconnecting all the sub-systems and controlling the system. The design of robotic architectures for mobile autonomous robots is a challenging and complex task. With a number of existing architectures and tools to choose from, a review of the existing robotic architecture is essential. This paper surveys the different paradigms in robotic architectures. A classification of the existing robotic architectures and comparison of different proposals attributes and properties have been carried out. The paper also provides a view on the current state of designing robot architectures. It also proposes a conceptual model of a generalised robotic architecture for mobile autonomous robots.Defence Science Journal, 2010, 60(1, pp.15-22, DOI:http://dx.doi.org/10.14429/dsj.60.96

  19. Precise image-guided irradiation of small animals: a flexible non-profit platform

    Science.gov (United States)

    Tillner, Falk; Thute, Prasad; Löck, Steffen; Dietrich, Antje; Fursov, Andriy; Haase, Robert; Lukas, Mathias; Rimarzig, Bernd; Sobiella, Manfred; Krause, Mechthild; Baumann, Michael; Bütof, Rebecca; Enghardt, Wolfgang

    2016-04-01

    Preclinical in vivo studies using small animals are essential to develop new therapeutic options in radiation oncology. Of particular interest are orthotopic tumour models, which better reflect the clinical situation in terms of growth patterns and microenvironmental parameters of the tumour as well as the interplay of tumours with the surrounding normal tissues. Such orthotopic models increase the technical demands and the complexity of preclinical studies as local irradiation with therapeutically relevant doses requires image-guided target localisation and accurate beam application. Moreover, advanced imaging techniques are needed for monitoring treatment outcome. We present a novel small animal image-guided radiation therapy (SAIGRT) system, which allows for precise and accurate, conformal irradiation and x-ray imaging of small animals. High accuracy is achieved by its robust construction, the precise movement of its components and a fast high-resolution flat-panel detector. Field forming and x-ray imaging is accomplished close to the animal resulting in a small penumbra and a high image quality. Feasibility for irradiating orthotopic models has been proven using lung tumour and glioblastoma models in mice. The SAIGRT system provides a flexible, non-profit academic research platform which can be adapted to specific experimental needs and therefore enables systematic preclinical trials in multicentre research networks.

  20. Clinical practice of image-guided spine radiosurgery - results from an international research consortium

    Directory of Open Access Journals (Sweden)

    Guckenberger Matthias

    2011-12-01

    Full Text Available Abstract Background Spinal radiosurgery is a quickly evolving technique in the radiotherapy and neurosurgical communities. However, the methods of spine radiosurgery have not been standardized. This article describes the results of a survey about the methods of spine radiosurgery at five international institutions. Methods All institutions are members of the Elekta Spine Radiosurgery Research Consortium and have a dedicated research and clinical focus on image-guided radiosurgery. The questionnaire consisted of 75 items covering all major steps of spine radiosurgery. Results Strong agreement in the methods of spine radiosurgery was observed. In particular, similarities were observed with safety and quality assurance playing an important role in the methods of all institutions, cooperation between neurosurgeons and radiation oncologists in case selection, dedicated imaging for target- and organ-at-risk delineation, application of proper safety margins for the target volume and organs-at-risk, conformal planning and precise image-guided treatment delivery, and close clinical and radiological follow-up. In contrast, three major areas of uncertainty and disagreement were identified: 1 Indications and contra-indications for spine radiosurgery; 2 treatment dose and fractionation and 3 tolerance dose of the spinal cord. Conclusions Results of this study reflect the current practice of spine radiosurgery in large academic centers. Despite close agreement was observed in many steps of spine radiosurgery, further research in form of retrospective and especially prospective studies is required to refine the details of spinal radiosurgery in terms of safety and efficacy.

  1. Clinical outcomes following 3D image-guided brachytherapy for vaginal recurrence of endometrial cancer.

    Science.gov (United States)

    Lee, Larissa J; Damato, Antonio L; Viswanathan, Akila N

    2013-12-01

    To evaluate clinical outcomes for women with recurrent endometrial cancer treated with 3D image-guided brachytherapy 44 women, of whom 13 had received prior RT, received salvage RT for vaginal recurrence from 9/03 to 8/11. HDR or LDR interstitial brachytherapy was performed under MR or CT guidance in 35 patients (80%); 9 (20%) had CT-guided HDR cylinder brachytherapy. The median cumulative dose in EQD2 was 75.5 Gy. Actuarial estimates of local failure (LF), disease-free (DFS) and overall survival (OS) were calculated by Kaplan-Meier. Histologic subtypes were endometrioid (EAC, 33), papillary serous/clear cell (UPSC/CC, 5) and carcinosarcoma (CS, 6). The 2-year DFS/OS rates were 75%/89% for EAC and 11%/24% for UPSC/CC/CS (both pradiotherapy. 3D image-guided brachytherapy results in excellent local control for women with recurrent endometrial cancer, particularly with cumulative EQD2 doses greater than 70 Gy. Successful salvage of vaginal recurrence is related to tumor grade and histologic subtype. © 2013.

  2. Ultrasound triggered image-guided drug delivery to inhibit vascular reconstruction via paclitaxel-loaded microbubbles.

    Science.gov (United States)

    Zhu, Xu; Guo, Jun; He, Cancan; Geng, Huaxiao; Yu, Gengsheng; Li, Jinqing; Zheng, Hairong; Ji, Xiaojuan; Yan, Fei

    2016-02-22

    Paclitaxel (PTX) has been recognized as a promising drug for intervention of vascular reconstructions. However, it is still difficult to achieve local drug delivery in a spatio-temporally controllable manner under real-time image guidance. Here, we introduce an ultrasound (US) triggered image-guided drug delivery approach to inhibit vascular reconstruction via paclitaxel (PTX)-loaded microbubbles (PLM) in a rabbit iliac balloon injury model. PLM was prepared through encapsulating PTX in the shell of lipid microbubbles via film hydration and mechanical vibration technique. Our results showed PLM could effectively deliver PTX when exposed to US irradiation and result in significantly lower viability of vascular smooth muscle cells. Ultrasonographic examinations revealed the US signals from PLM in the iliac artery were greatly increased after intravenous administration of PLM, making it possible to identify the restenosis regions of iliac artery. The in vivo anti-restenosis experiments with PLM and US greatly inhibited neointimal hyperplasia at the injured site, showing an increased lumen area and reduced the ratio of intima area and the media area (I/M ratio). No obvious functional damages to liver and kidney were observed for those animals. Our study provided a promising approach to realize US triggered image-guided PTX delivery for therapeutic applications against iliac restenosis.

  3. Quality Assurance of Multiport Image-Guided Minimally Invasive Surgery at the Lateral Skull Base

    Directory of Open Access Journals (Sweden)

    Maria Nau-Hermes

    2014-01-01

    Full Text Available For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG, which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes.

  4. Image-guided radiotherapy platform using single nodule conditional lung cancer mouse models.

    Science.gov (United States)

    Herter-Sprie, Grit S; Korideck, Houari; Christensen, Camilla L; Herter, Jan M; Rhee, Kevin; Berbeco, Ross I; Bennett, David G; Akbay, Esra A; Kozono, David; Mak, Raymond H; Mike Makrigiorgos, G; Kimmelman, Alec C; Wong, Kwok-Kin

    2014-12-18

    Close resemblance of murine and human trials is essential to achieve the best predictive value of animal-based translational cancer research. Kras-driven genetically engineered mouse models of non-small-cell lung cancer faithfully predict the response of human lung cancers to systemic chemotherapy. Owing to development of multifocal disease, however, these models have not been usable in studies of outcomes following focal radiotherapy (RT). We report the development of a preclinical platform to deliver state-of-the-art image-guided RT in these models. Presence of a single tumour as usually diagnosed in patients is modelled by confined injection of adenoviral Cre recombinase. Furthermore, three-dimensional conformal planning and state-of-the-art image-guided dose delivery are performed as in humans. We evaluate treatment efficacies of two different radiation regimens and find that Kras-driven tumours can temporarily be stabilized upon RT, whereas additional loss of either Lkb1 or p53 renders these lesions less responsive to RT.

  5. An integrated orthognathic surgery system for virtual planning and image-guided transfer without intermediate splint.

    Science.gov (United States)

    Kim, Dae-Seung; Woo, Sang-Yoon; Yang, Hoon Joo; Huh, Kyung-Hoe; Lee, Sam-Sun; Heo, Min-Suk; Choi, Soon-Chul; Hwang, Soon Jung; Yi, Won-Jin

    2014-12-01

    Accurate surgical planning and transfer of the planning in orthognathic surgery are very important in achieving a successful surgical outcome with appropriate improvement. Conventionally, the paper surgery is performed based on a 2D cephalometric radiograph, and the results are expressed using cast models and an articulator. We developed an integrated orthognathic surgery system with 3D virtual planning and image-guided transfer. The maxillary surgery of orthognathic patients was planned virtually, and the planning results were transferred to the cast model by image guidance. During virtual planning, the displacement of the reference points was confirmed by the displacement from conventional paper surgery at each procedure. The results of virtual surgery were transferred to the physical cast models directly through image guidance. The root mean square (RMS) difference between virtual surgery and conventional model surgery was 0.75 ± 0.51 mm for 12 patients. The RMS difference between virtual surgery and image-guidance results was 0.78 ± 0.52 mm, which showed no significant difference from the difference of conventional model surgery. The image-guided orthognathic surgery system integrated with virtual planning will replace physical model surgical planning and enable transfer of the virtual planning directly without the need for an intermediate splint.

  6. Anser EMT: the first open-source electromagnetic tracking platform for image-guided interventions.

    Science.gov (United States)

    Jaeger, Herman Alexander; Franz, Alfred Michael; O'Donoghue, Kilian; Seitel, Alexander; Trauzettel, Fabian; Maier-Hein, Lena; Cantillon-Murphy, Pádraig

    2017-06-01

    Electromagnetic tracking is the gold standard for instrument tracking and navigation in the clinical setting without line of sight. Whilst clinical platforms exist for interventional bronchoscopy and neurosurgical navigation, the limited flexibility and high costs of electromagnetic tracking (EMT) systems for research investigations mitigate against a better understanding of the technology's characterisation and limitations. The Anser project provides an open-source implementation for EMT with particular application to image-guided interventions. This work provides implementation schematics for our previously reported EMT system which relies on low-cost acquisition and demodulation techniques using both National Instruments and Arduino hardware alongside MATLAB support code. The system performance is objectively compared to other commercial tracking platforms using the Hummel assessment protocol. Positional accuracy of 1.14 mm and angular rotation accuracy of [Formula: see text] are reported. Like other EMT platforms, Anser is susceptible to tracking errors due to eddy current and ferromagnetic distortion. The system is compatible with commercially available EMT sensors as well as the Open Network Interface for image-guided therapy (OpenIGTLink) for easy communication with visualisation and medical imaging toolkits such as MITK and 3D Slicer. By providing an open-source platform for research investigations, we believe that novel and collaborative approaches can overcome the limitations of current EMT technology.

  7. MoO3-x quantum dots for photoacoustic imaging guided photothermal/photodynamic cancer treatment.

    Science.gov (United States)

    Ding, Dandan; Guo, Wei; Guo, Chongshen; Sun, Jianzhe; Zheng, Nannan; Wang, Fei; Yan, Mei; Liu, Shaoqin

    2017-02-02

    A theranostic system of image-guided phototherapy is considered as a potential technique for cancer treatment because of the ability to integrate diagnostics and therapies together, thus enhancing accuracy and visualization during the treatment. In this work, we realized photoacoustic (PA) imaging-guided photothermal (PT)/photodynamic (PD) combined cancer treatment just via a single material, MoO3-x quantum dots (QDs). Due to their strong NIR harvesting ability, MoO3-x QDs can convert incident light into hyperthermia and sensitize the formation of singlet oxygen synchronously as evidenced by in vitro assay, hence, they can behave as both PT and PD agents effectively and act as a "dual-punch" to cancer cells. In a further study, elimination of solid tumors from HeLa-tumor bearing mice could be achieved in a MoO3-x QD mediated phototherapeutic group without obvious lesions to the major organs. In addition, the desired PT effect also makes MoO3-x QDs an exogenous PA contrast agent for in vivo live-imaging to depict tumors. Compared with previously reported theranostic systems that put several components into one system, our multifunctional agent of MoO3-x QDs is exempt from unpredictable mutual interference between components and ease of leakage of virtual components from the composited system.

  8. Imaging guided interventional procedures in paediatric uroradiology--a case based overview

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, M. E-mail: michael.riccabona@kfunigraz.ac.at; Sorantin, E.; Hausegger, K

    2002-08-01

    Objective: To describe the potential and application of interventional image guided procedures in the paediatric urinary tract. Patients and methods: The different techniques are illustrated using case reports. The examples comprise established indications such as percutaneous nephrostomy for compromised kidneys in obstructive uropathy and infection, sonographic guided renal biopsy including monitoring or treatment of complications after biopsy, and evaluation and balloon dilatation of childhood renal artery stenosis. There are new applications such as treatment of stenosis in cutaneous ureterostomy or sonographically guided catheterism for deployment of therapeutic agents. Results: Generally, the procedures are safe and successful. However, complications may occur, and peri-/post-interventional monitoring is mandatory to insure early detection and adequate management. Sometimes additional treatment such as percutaneous embolisation of a symptomatic post biopsy arterio-venous fistula, or a second biopsy for recurrent disease may become necessary. Conclusion: Imaging guided interventional procedures are performed successfully in a variety of diseases of the paediatric urinary tract. They can be considered a valuable additional modality throughout infancy and childhood.

  9. High contrast optical imaging methods for image guided laser ablation of dental caries lesions

    Science.gov (United States)

    LaMantia, Nicole R.; Tom, Henry; Chan, Kenneth H.; Simon, Jacob C.; Darling, Cynthia L.; Fried, Daniel

    2014-02-01

    Laser based methods are well suited for automation and can be used to selectively remove dental caries to minimize the loss of healthy tissues and render the underlying enamel more resistant to acid dissolution. The purpose of this study was to determine which imaging methods are best suited for image-guided ablation of natural non-cavitated carious lesions on occlusal surfaces. Multiple caries imaging methods were compared including near-IR and visible reflectance and quantitative light fluorescence (QLF). In order for image-guided laser ablation to be feasible, chemical and physical modification of tooth surfaces due to laser irradiation cannot greatly reduce the contrast between sound and demineralized dental hard tissues. Sound and demineralized surfaces of 48 extracted human molar teeth with non-cavitated lesions were examined. Images were acquired before and after laser irradiation using visible and near-IR reflectance and QLF at several wavelengths. Polarization sensitive-optical coherence tomography was used to confirm that lesions were present. The highest contrast was attained at 1460-nm and 1500-1700-nm, wavelengths coincident with higher water absorption. The reflectance did not decrease significantly after laser irradiation for those wavelengths.

  10. Image-guided Spine Stabilization for Traumatic or Osteoporotic Spine Injury: Radiological Accuracy and Neurological Outcome

    Science.gov (United States)

    SHIMOKAWA, Nobuyuki; ABE, Junya; SATOH, Hidetoshi; ARIMA, Hironori; TAKAMI, Toshihiro

    2016-01-01

    Significant progress has been made in image-guided surgery (IGS) over the last few decades. IGS can be effectively applied to spinal instrumentation surgery. In the present study, we focused our attention on the feasibility and safety of image-guided spine stabilization for traumatic or osteoporotic spine injury. The IGS spine fixation with or without minimally invasive surgery (MIS) techniques such as percutaneous screw placement, balloon kyphoplasty (BKP), or vertebroplasty (VP) were accomplished in 80 patients with traumatic or osteoprotic spine injury between 2007 and 2015. The injured vertebral levels included the following: cervical spine, 41; thoracic spine, 22; and lumbar spine, 17. Neurological condition before and after surgery was assessed using the American Spinal Injury Association Impairment Scale (AIS). A total of 419 pedicle, lateral mass, or laminar screws were placed, and 399 screws (95.2%) were found to be placed correctly based on postoperative computed tomography scan. Although 20 screws (4.8%) were found to be unexpectedly placed incorrectly, no neural or vascular complications closely associated with screw placement were encountered. Neurological outcomes appeared to be acceptable or successful based on AIS. The IGS is a promising technique that can improve the accuracy of screw placement and reduce potential injury to critical neurovascular structures. The integration of MIS and IGS has proved feasible and safe in the treatment of traumatic or osteoporotic spine injury, although a thorough knowledge of surgical anatomy, spine biomechanics, and basic technique remain the most essential aspects for a successful surgery. PMID:27063144

  11. microMS: A Python Platform for Image-Guided Mass Spectrometry Profiling

    Science.gov (United States)

    Comi, Troy J.; Neumann, Elizabeth K.; Do, Thanh D.; Sweedler, Jonathan V.

    2017-09-01

    Image-guided mass spectrometry (MS) profiling provides a facile framework for analyzing samples ranging from single cells to tissue sections. The fundamental workflow utilizes a whole-slide microscopy image to select targets of interest, determine their spatial locations, and subsequently perform MS analysis at those locations. Improving upon prior reported methodology, a software package was developed for working with microscopy images. microMS, for microscopy-guided mass spectrometry, allows the user to select and profile diverse samples using a variety of target patterns and mass analyzers. Written in Python, the program provides an intuitive graphical user interface to simplify image-guided MS for novice users. The class hierarchy of instrument interactions permits integration of new MS systems while retaining the feature-rich image analysis framework. microMS is a versatile platform for performing targeted profiling experiments using a series of mass spectrometers. The flexibility in mass analyzers greatly simplifies serial analyses of the same targets by different instruments. The current capabilities of microMS are presented, and its application for off-line analysis of single cells on three distinct instruments is demonstrated. The software has been made freely available for research purposes. [Figure not available: see fulltext.

  12. Endoscopic laser speckle contrast imaging system using a fibre image guide

    Science.gov (United States)

    Song, Lipei; Elson, Daniel

    2011-03-01

    There are several challenges when fibre image guides (FIG) are used for endoscopic speckle acquisition: cross talk between fibre cores, FIG fixed pattern noise, the small probe diameter and low sensitivity and resolution due to the decreased number of speckles and their low transmission through the FIG. In this paper, an endoscopic laser speckle contrast analysis system (ELASCA) based on a leached fibre image guide (LFIG) is presented. Different methods of acquiring LASCA images through LFIGs were investigated including the effect of changing the number of speckles per fibre, defocusing the FIG image onto the CCD and processing speckle images with masks and Butterworth filters to deal with the LFIG fixed pattern and noise from the cladding. The experimental results based on a phantom consisting of intralipid suspension pumped at varying speed showed that this system could detect speed changes and that in the case of multiple speckles per fibre the Nyquist frequency criterion need not be applied since the speckle may be transferred through the fibres to some extent. In contrast to the previously reported ELASCA results, this system can both give a map of the observed area and the temporal change in flow. An additional benefit is the small size of the LFIG, which is compatible with current endoscopic instrument channels and may allow additional surgical applications.

  13. microMS: A Python Platform for Image-Guided Mass Spectrometry Profiling

    Science.gov (United States)

    Comi, Troy J.; Neumann, Elizabeth K.; Do, Thanh D.; Sweedler, Jonathan V.

    2017-06-01

    Image-guided mass spectrometry (MS) profiling provides a facile framework for analyzing samples ranging from single cells to tissue sections. The fundamental workflow utilizes a whole-slide microscopy image to select targets of interest, determine their spatial locations, and subsequently perform MS analysis at those locations. Improving upon prior reported methodology, a software package was developed for working with microscopy images. microMS, for microscopy-guided mass spectrometry, allows the user to select and profile diverse samples using a variety of target patterns and mass analyzers. Written in Python, the program provides an intuitive graphical user interface to simplify image-guided MS for novice users. The class hierarchy of instrument interactions permits integration of new MS systems while retaining the feature-rich image analysis framework. microMS is a versatile platform for performing targeted profiling experiments using a series of mass spectrometers. The flexibility in mass analyzers greatly simplifies serial analyses of the same targets by different instruments. The current capabilities of microMS are presented, and its application for off-line analysis of single cells on three distinct instruments is demonstrated. The software has been made freely available for research purposes.

  14. Image guided surgery innovation with graduate students - a new lecture format

    Directory of Open Access Journals (Sweden)

    Friebe Michael

    2015-09-01

    Full Text Available In Image Guided Surgeries (IGS, incremental innovation is normally not a technology push (technology delivered but rather a pull (by learning and working with the clinical users from understanding how these surgeries are performed. Engineers need to understand that only through proper observation, procedure know-how and subsequent analysis and evaluation, clinically relevant innovation can be generated. And, it is also essential to understand the associated health economics that could potentially come with new technological approaches. We created a new lecture format (6 ECTS for graduate students that combined the basics of image guided procedures with innovation tools (Design Thinking, Lean Engineering, Value Proposition Canvas, Innovation Games and actual visits of a surgical procedure. The students had to attend these procedures in small groups and had to identify and work on one or more innovation projects based on their observations and based on a prioritisation of medical need, pains and gains of the stakeholders, and ease of implementation. Almost 200 graduate students completed this training in the past 5 years with excellent results for the participating clinicians, and for the future engineers. This paper presents the lecture content, the setup, some statistics and results with the hope that other institutions will follow to offer similar programs that not only help the engineering students identify what clinically relevant innovation is (invention x clinical implementation, but that also pave the path for future interdisciplinary teams that will lead to incremental and disruptive innovation.

  15. SU-E-J-205: Monte Carlo Modeling of Ultrasound Probes for Real-Time Ultrasound Image-Guided Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hristov, D; Schlosser, J; Bazalova, M [Stanford Universtiy, Stanford, CA (United States); Chen, J [UCSF Comprehensive Cancer Center, Lafayette, CA (United States)

    2014-06-01

    Purpose: To quantify the effect of ultrasound (US) probe beam attenuation for radiation therapy delivered under real-time US image guidance by means of Monte Carlo (MC) simulations. Methods: MC models of two Philips US probes, an X6-1 matrix-array transducer and a C5-2 curved-array transducer, were built based on their CT images in the EGSnrc BEAMnrc and DOSXYZnrc codes. Due to the metal parts, the probes were scanned in a Tomotherapy machine with a 3.5 MV beam. Mass densities in the probes were assigned based on an electron density calibration phantom consisting of cylinders with mass densities between 0.2–8.0 g/cm{sup 3}. Beam attenuation due to the probes was measured in a solid water phantom for a 6 MV and 15 MV 15x15 cm{sup 2} beam delivered on a Varian Trilogy linear accelerator. The dose was measured with the PTW-729 ionization chamber array at two depths and compared to MC simulations. The extreme case beam attenuation expected in robotic US image guided radiotherapy for probes in upright position was quantified by means of MC simulations. Results: The 3.5 MV CT number to mass density calibration curve was found to be linear with R{sup 2} > 0.99. The maximum mass densities were 4.6 and 4.2 g/cm{sup 3} in the C5-2 and X6-1 probe, respectively. Gamma analysis of the simulated and measured doses revealed that over 98% of measurement points passed the 3%/3mm criteria for both probes and measurement depths. The extreme attenuation for probes in upright position was found to be 25% and 31% for the C5-2 and X6-1 probe, respectively, for both 6 and 15 MV beams at 10 cm depth. Conclusion: MC models of two US probes used for real-time image guidance during radiotherapy have been built. As a Result, radiotherapy treatment planning with the imaging probes in place can now be performed. J Schlosser is an employee of SoniTrack Systems, Inc. D Hristov has financial interest in SoniTrack Systems, Inc.

  16. Stereotactic Irradiation of Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    To investigate the best stereotactic irradiation (STI) technique in treatment of small lung tumors, using dose-volume statistics. Methods: Dose-volume histogram (DVH) of the study phantom consisting of CT using the software of FOCUS-3D planning system. The beam was a 6MV X-ray from a Varian 2300C. The analysis data of Dose-volume statistics was from the technique used for: (1) 2- 12 arcs; (2) 20° - 45° separation angle of arcs; (3) 80° - 160° of gantry rotation. Then we studied the difference of DVH with various irradiation techniques and the influence of target positions and field size by calculated to the distribution of dose from 20%- 90% of the six targets in the lung with 3×3 cm2, 4′ 4 cm2 and 5′ 5 cm2 field size. Results: The volume irradiated pulmonary tissue was the smallest using a six non-coplanar 120° arcs with 30° separation between arcs in the hypothetical set up, the non-coplanar SRI was superiority than conventional one's. The six targets were chosen in the right lung, the volume was the largest in geometric center and was decreased in hilus, bottom, anterior chest wall, lateral wall and apex of the lung in such an order. The DVH had significant change with an increasing field size. Conclusion: the irradiation damage of normal pulmonary tissue was the lowest using the six non-coplanar 120° arcs with a 30° separation between arcs by <5×5 cm2 field and the position of target was not a restricting factor.

  17. Current Capabilities and Development Potential in Surgical Robotics

    Directory of Open Access Journals (Sweden)

    Mathias Hoeckelmann

    2015-05-01

    Full Text Available Commercial surgical robots have been in clinical use since the mid-1990s, supporting surgeons in various tasks. In the past decades, many systems emerged as research platforms, and a few entered the global market. This paper summarizes the currently available surgical systems and research directions in the broader field of surgical robotics. The widely deployed teleoperated manipulators aim to enhance human cognitive and physical skills and provide smart tools for surgeons, while image-guided robotics focus on surpassing human limitations by introducing automated targeting and treatment delivery methods. Both concepts are discussed based on prototypes and commercial systems. Through concrete examples the possible future development paths of surgical robots are illustrated. While research efforts are taking different approaches to improve the capacity of such systems, the aim of this survey is to assess their maturity from the commercialization point of view.

  18. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

    Directory of Open Access Journals (Sweden)

    Murray JR

    2015-11-01

    Full Text Available Julia R Murray,1,2 Helen A McNair,2 David P Dearnaley1,2 1Academic Urology Unit, Institute of Cancer Research, London, 2Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK Abstract: The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion. Keywords: radiotherapy, prostate cancer, post-prostatectomy, image-guided radiation therapy

  19. Motion-compensated hand-held common-path Fourier-domain optical coherence tomography probe for image-guided intervention

    Science.gov (United States)

    Huang, Yong; Song, Cheol; Liu, Xuan; Kang, Jin U.

    2013-03-01

    A motion-compensated hand-held common-path Fourier-domain optical coherence tomography imaging probe has been developed for image guided intervention during microsurgery. A hand-held prototype instrument was designed and fabricated by integrating an imaging fiber probe inside a stainless steel needle which is attached to the ceramic shaft of a piezoelectric motor housed in an aluminum handle. The fiber probe obtains A-scan images. The distance information was extracted from the A-scans to track the sample surface distance and a fixed distance was maintained by a feedback motor control which effectively compensated hand tremor and target movements in the axial direction. Graphical user interface, real-time data processing, and visualization based on a CPU-GPU hybrid programming architecture were developed and used in the implantation of this system. To validate the system, free-hand optical coherence tomography images using various samples were obtained. The system can be easily integrated into microsurgical tools and robotics for a wide range of clinical applications. Such tools could offer physicians the freedom to easily image sites of interest with reduced risk and higher image quality.

  20. Multi-institutional MicroCT image comparison of image-guided small animal irradiators

    Science.gov (United States)

    Johnstone, Chris D.; Lindsay, Patricia; E Graves, Edward; Wong, Eugene; Perez, Jessica R.; Poirier, Yannick; Ben-Bouchta, Youssef; Kanesalingam, Thilakshan; Chen, Haijian; E Rubinstein, Ashley; Sheng, Ke; Bazalova-Carter, Magdalena

    2017-07-01

    To recommend imaging protocols and establish tolerance levels for microCT image quality assurance (QA) performed on conformal image-guided small animal irradiators. A fully automated QA software SAPA (small animal phantom analyzer) for image analysis of the commercial Shelley micro-CT MCTP 610 phantom was developed, in which quantitative analyses of CT number linearity, signal-to-noise ratio (SNR), uniformity and noise, geometric accuracy, spatial resolution by means of modulation transfer function (MTF), and CT contrast were performed. Phantom microCT scans from eleven institutions acquired with four image-guided small animal irradiator units (including the commercial PXi X-RAD SmART and Xstrahl SARRP systems) with varying parameters used for routine small animal imaging were analyzed. Multi-institutional data sets were compared using SAPA, based on which tolerance levels for each QA test were established and imaging protocols for QA were recommended. By analyzing microCT data from 11 institutions, we established image QA tolerance levels for all image quality tests. CT number linearity set to R 2  >  0.990 was acceptable in microCT data acquired at all but three institutions. Acceptable SNR  >  36 and noise levels  1.5 lp mm-1 for MTF  =  0.2) was obtained at all but four institutions due to their large image voxel size used (>0.275 mm). Ten of the eleven institutions passed the set QA tolerance for geometric accuracy (2000 HU for 30 mgI ml-1). We recommend performing imaging QA with 70 kVp, 1.5 mA, 120 s imaging time, 0.20 mm voxel size, and a frame rate of 5 fps for the PXi X-RAD SmART. For the Xstrahl SARRP, we recommend using 60 kVp, 1.0 mA, 240 s imaging time, 0.20 mm voxel size, and 6 fps. These imaging protocols should result in high quality images that pass the set tolerance levels on all systems. Average SAPA computation time for complete QA analysis for a 0.20 mm voxel, 400 slice Shelley phantom microCT data set

  1. Electromagnetic image-guided orbital decompression: technique, principles, and preliminary experience with 6 consecutive cases.

    Science.gov (United States)

    Servat, Juan J; Elia, Maxwell Dominic; Gong, Dan; Manes, R Peter; Black, Evan H; Levin, Flora

    2014-12-01

    To assess the feasibility of routine use of electromagnetic image guidance systems in orbital decompression. Six consecutive patients underwent stereotactic-guided three wall orbital decompression using the novel Fusion ENT Navigation System (Medtronic), a portable and expandable electromagnetic guidance system with multi-instrument tracking capabilities. The system consists of the Medtronic LandmarX System software-enabled computer station, signal generator, field-generating magnet, head-mounted marker coil, and surgical tracking instruments. In preparation for use of the LandmarX/Fusion protocol, all patients underwent preoperative non-contrast CT scan from the superior aspect of the frontal sinuses to the inferior aspect of the maxillary sinuses that includes the nasal tip. The Fusion ENT Navigation System (Medtronic™) was used in 6 patients undergoing maximal 3-wall orbital decompression for Graves' orbitopthy after a minimum of six months of disease inactivity. Preoperative Hertel exophthalmometry measured more than 27 mm in all patients. The navigation system proved to be no more difficult technically than the traditional orbital decompression approach. Electromagnetic image guidance is a stereotactic surgical navigation system that provides additional intraoperative flexibility in orbital surgery. Electromagnetic image-guidance offers the ability to perform more aggressive orbital decompressions with reduced risk.

  2. Image-guided percutaneous procedures in deep pelvic sites: review of the main approaches

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Rodrigo Gobbo; Macedo Filho, Carlos Leite de; Maurano, Alexandre; Francisco Neto, Miguel Jose; Daniel, Mauro Miguel; Rosemberg, Laercio Alberto [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil). Setor de Radiologia Intervencionista Nao-Vascular]. E-mail: rogarcia@usp.br; Funari, Marcelo Buarque de Gusmao [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil). Dept. de Radiologia

    2008-09-15

    Image-guided percutaneous procedures have increasingly been established as safe and effective interventional tools in the diagnosis and management of masses and collections in several body segments. However, lesions in deep pelvic sites still pose a challenge for radiologists because of overlying anatomic structures. The success of a percutaneous biopsy depends on a safe access route planning based on a deep understanding of cross sectional anatomy of the pelvis. Anterior and lateral transabdominal, anterolateral extraperitoneal, transvaginal, transrectal and transgluteal approaches are described. The present study was aimed at reviewing the normal pelvic cross-sectional anatomy, demonstrating the different access routes for ultrasonography and computed tomography guided pelvic biopsies and drainages as well as discussing the main advantages and complications associated with these approaches. (author)

  3. Robust 3-D airway tree segmentation for image-guided peripheral bronchoscopy.

    Science.gov (United States)

    Graham, Michael W; Gibbs, Jason D; Cornish, Duane C; Higgins, William E

    2010-04-01

    A vital task in the planning of peripheral bronchoscopy is the segmentation of the airway tree from a 3-D multidetector computed tomography chest scan. Unfortunately, existing methods typically do not sufficiently extract the necessary peripheral airways needed to plan a procedure. We present a robust method that draws upon both local and global information. The method begins with a conservative segmentation of the major airways. Follow-on stages then exhaustively search for additional candidate airway locations. Finally, a graph-based optimization method counterbalances both the benefit and cost of retaining candidate airway locations for the final segmentation. Results demonstrate that the proposed method typically extracts 2-3 more generations of airways than several other methods, and that the extracted airway trees enable image-guided bronchoscopy deeper into the human lung periphery than past studies.

  4. A 3-D visualization method for image-guided brain surgery.

    Science.gov (United States)

    Bourbakis, N G; Awad, M

    2003-01-01

    This paper deals with a 3D methodology for brain tumor image-guided surgery. The methodology is based on development of a visualization process that mimics the human surgeon behavior and decision-making. In particular, it originally constructs a 3D representation of a tumor by using the segmented version of the 2D MRI images. Then it develops an optimal path for the tumor extraction based on minimizing the surgical effort and penetration area. A cost function, incorporated in this process, minimizes the damage surrounding healthy tissues taking into consideration the constraints of a new snake-like surgical tool proposed here. The tumor extraction method presented in this paper is compared with the ordinary method used on brain surgery, which is based on a straight-line based surgical tool. Illustrative examples based on real simulations present the advantages of the 3D methodology proposed here.

  5. Polypyrrole Hollow Microspheres as Echogenic Photothermal Agent for Ultrasound Imaging Guided Tumor Ablation

    Science.gov (United States)

    Zha, Zhengbao; Wang, Jinrui; Qu, Enze; Zhang, Shuhai; Jin, Yushen; Wang, Shumin; Dai, Zhifei

    2013-01-01

    Ultrasound (US) imaging provides a valuable opportunity to administer photothermal therapy (PTT) of cancer with real-time guidance to ensure proper targeting, but only a few theranostic agents were developed by physically grafting near infrared (NIR)-absorbing inorganic nanomaterials to ready-made ultrasound contrast agents (UCAs) for US imaging guided PTT. In this paper, NIR absorbing hollow microspheres were generated from polypyrrole merely using a facile one-step microemulsion method. It was found that the obtained polypyrrole hollow microspheres (PPyHMs) can act as an efficient theranostic agent not only to enhance US imaging greatly, but also exhibit excellent photohyperthermic effects. The contrast consistently sustained the echo signals for no less than 5 min and the NIR laser light ablated the tumor completely within two weeks in the presence of PPyHMs. More importantly, no use of additional NIR absorber substantially minimizes an onetime dose of the theranostic agent. PMID:23912977

  6. A novel thermal accelerant for augmentation of microwave energy during image-guided tumor ablation

    Science.gov (United States)

    Park, William K. C.; Maxwell, Aaron W. P.; Frank, Victoria E.; Primmer, Michael P.; Paul, Jarod B.; Susai, Cynthia; Collins, Scott A.; Borjeson, Tiffany M.; Baird, Greyson L.; Lombardo, Kara A.; Dupuy, Damian E.

    2017-02-01

    The greatest challenge in image-guided thermal ablation (IGTA) of liver tumors is a relatively high recurrence rate (ca. 30%) due to incomplete ablation. To meet this challenge, we have developed a novel Thermal Accelerator (TA) to demonstrate its capability to, 1) augment microwave (MW) energy from a distance unattainable by antenna alone; 2) turn into a gel at body temperature; 3) act as a CT or US contrast. We have examined the TA efficiency using in vitro and ex vivo models: microwave power, TA dose, frequencies and TA-to-tip distance were varied, and temperature readings compared with and without TA. Using the in vitro model, it was established that both the rate and magnitude of increase in ablation zone temperature were significantly greater with TA under all tested conditions (panimal model are consistent with the observations made in in vitro and en vivo studies.

  7. Single camera imaging system for color and near-infrared fluorescence image guided surgery.

    Science.gov (United States)

    Chen, Zhenyue; Zhu, Nan; Pacheco, Shaun; Wang, Xia; Liang, Rongguang

    2014-08-01

    Near-infrared (NIR) fluorescence imaging systems have been developed for image guided surgery in recent years. However, current systems are typically bulky and work only when surgical light in the operating room (OR) is off. We propose a single camera imaging system that is capable of capturing NIR fluorescence and color images under normal surgical lighting illumination. Using a new RGB-NIR sensor and synchronized NIR excitation illumination, we have demonstrated that the system can acquire both color information and fluorescence signal with high sensitivity under normal surgical lighting illumination. The experimental results show that ICG sample with concentration of 0.13 μM can be detected when the excitation irradiance is 3.92 mW/cm(2) at an exposure time of 10 ms.

  8. Surface-functionalized nanoparticles for biosensing and imaging-guided therapeutics.

    Science.gov (United States)

    Jiang, Shan; Win, Khin Yin; Liu, Shuhua; Teng, Choon Peng; Zheng, Yuangang; Han, Ming-Yong

    2013-04-21

    In this article, the very recent progress of various functional inorganic nanomaterials is reviewed including their unique properties, surface functionalization strategies, and applications in biosensing and imaging-guided therapeutics. The proper surface functionalization renders them with stability, biocompatibility and functionality in physiological environments, and further enables their targeted use in bioapplications after bioconjugation via selective and specific recognition. The surface-functionalized nanoprobes using the most actively studied nanoparticles (i.e., gold nanoparticles, quantum dots, upconversion nanoparticles, and magnetic nanoparticles) make them an excellent platform for a wide range of bioapplications. With more efforts in recent years, they have been widely developed as labeling probes to detect various biological species such as proteins, nucleic acids and ions, and extensively employed as imaging probes to guide therapeutics such as drug/gene delivery and photothermal/photodynamic therapy.

  9. Image-guided therapy system for interstitial gynecologic brachytherapy in a multimodality operating suite

    CERN Document Server

    Egger, Jan

    2013-01-01

    In this contribution, an image-guided therapy system supporting gynecologic radiation therapy is introduced. The overall workflow of the presented system starts with the arrival of the patient and ends with follow-up examinations by imaging and a superimposed visualization of the modeled device from a PACS system. Thereby, the system covers all treatments stages (pre-, intra- and postoperative) and has been designed and constructed by a computer scientist with feedback from an interdisciplinary team of physicians and engineers. This integrated medical system enables dispatch of diagnostic images directly after acquisition to a processing workstation that has an on-board 3D Computer Aided Design model of a medical device. Thus, allowing precise identification of catheter location in the 3D imaging model which later provides rapid feedback to the clinician regarding device location. Moreover, the system enables the ability to perform patient-specific pre-implant evaluation by assessing the placement of intersti...

  10. A Porcine Liver Model for Validation of Registration Accuracy in Image-Guided Surgery

    Science.gov (United States)

    Peterhans, Matthias; Dagon, Benoît; Berg, Anne Vom; Inderbitzin, Daniel; Baur, Charles; Weber, Stefan

    Correct registration between pre-operative high-resolution images and intra-operative data of lower detail is a fundamental requirement in image-guided liver surgery. We propose a multi modality liver model for measuring the accuracy of such registration methods. A freshly explanted porcine liver is artificially perfused by a peristaltic pump and liver motion is simulated by means of inflatable objects positioned around the liver. Co-registered ultrasound and CT data sets are acquired in different deformation scenarios and allow compar-ing registration outcomes with a CT data set serving as ground truth. The pre-sent work describes the experimental setup and summarizes the results from ultrasound and CT imaging.

  11. Surface-functionalized nanoparticles for biosensing and imaging-guided therapeutics

    Science.gov (United States)

    Jiang, Shan; Win, Khin Yin; Liu, Shuhua; Teng, Choon Peng; Zheng, Yuangang; Han, Ming-Yong

    2013-03-01

    In this article, the very recent progress of various functional inorganic nanomaterials is reviewed including their unique properties, surface functionalization strategies, and applications in biosensing and imaging-guided therapeutics. The proper surface functionalization renders them with stability, biocompatibility and functionality in physiological environments, and further enables their targeted use in bioapplications after bioconjugation via selective and specific recognition. The surface-functionalized nanoprobes using the most actively studied nanoparticles (i.e., gold nanoparticles, quantum dots, upconversion nanoparticles, and magnetic nanoparticles) make them an excellent platform for a wide range of bioapplications. With more efforts in recent years, they have been widely developed as labeling probes to detect various biological species such as proteins, nucleic acids and ions, and extensively employed as imaging probes to guide therapeutics such as drug/gene delivery and photothermal/photodynamic therapy.

  12. The MITK image guided therapy toolkit and its application for augmented reality in laparoscopic prostate surgery

    Science.gov (United States)

    Baumhauer, Matthias; Neuhaus, Jochen; Fritzsche, Klaus; Meinzer, Hans-Peter

    2010-02-01

    Image Guided Therapy (IGT) faces researchers with high demands and efforts in system design, prototype implementation, and evaluation. The lack of standardized software tools, like algorithm implementations, tracking device and tool setups, and data processing methods escalate the labor for system development and sustainable system evaluation. In this paper, a new toolkit component of the Medical Imaging and Interaction Toolkit (MITK), the MITK-IGT, and its exemplary application for computer-assisted prostate surgery are presented. MITK-IGT aims at integrating software tools, algorithms and tracking device interfaces into the MITK toolkit to provide a comprehensive software framework for computer aided diagnosis support, therapy planning, treatment support, and radiological follow-up. An exemplary application of the MITK-IGT framework is introduced with a surgical navigation system for laparos-copic prostate surgery. It illustrates the broad range of application possibilities provided by the framework, as well as its simple extensibility with custom algorithms and other software modules.

  13. Image-guided radiotherapy for locally advanced head and neck cancer

    Directory of Open Access Journals (Sweden)

    Nam Phong Nguyen

    2013-07-01

    Full Text Available Treatment of locally advanced head and neck cancer remains a challenge because of the head and neck complex anatomy and the tumor invasion to the adjacent organs and/or metastases to the cervical nodes. Postoperative irradiation or concurrent chemoradiation may lead to damage of radiosensitive structures such as the salivary glands, mandible, cochlea, larynx, and pharyngeal muscles. Xerostomia, osteoradionecrosis, deafness, hoarseness of the voice, dysphagia, and aspiration remain serious complications of head and neck irradiation and impair patient quality of life. Intensity-modulated and image-guided radiotherapy by virtue of steep dose gradient and daily imaging may allow for decreased radiation of the organs at risk for complication while preserving loco-regional control.

  14. The potential role of magnetic resonance spectroscopy in image-guided radiotherapy

    Directory of Open Access Journals (Sweden)

    Mai Lin Nguyen

    2014-05-01

    Full Text Available Magnetic resonance spectroscopy (MRS is a non-invasive technique to detect metabolites within the normal and tumoral tissues. The ability of MRS to diagnose areas of high metabolic activity linked to tumor cell proliferation is particularly useful for radiotherapy treatment planning because of better gross tumor volume (GTV delineation. The GTV may be targeted with higher radiation dose, potentially improving local control without excessive irradiation to the normal adjacent tissues. Prostate cancer and glioblastoma multiforme (GBM are two tumor models that are associated with a heterogeneous tumor distribution. Preliminary studies suggest that the integration of MRS into radiotherapy planning for these tumors is feasible and safe. Image-guided radiotherapy (IGRT by virtue of daily tumor imaging and steep dose gradient may allow for tumor dose escalation with the simultaneous integrated boost technique (SIB and potentially decrease the complications rates in patients with GBM and prostate cancers.

  15. The safety issues of medical robotics

    Energy Technology Data Exchange (ETDEWEB)

    Fei Baowei; Ng, W.S.; Chauhan, Sunita; Kwoh, Chee Keong

    2001-08-01

    In this paper, we put forward a systematic method to analyze, control and evaluate the safety issues of medical robotics. We created a safety model that consists of three axes to analyze safety factors. Software and hardware are the two material axes. The third axis is the policy that controls all phases of design, production, testing and application of the robot system. The policy was defined as hazard identification and safety insurance control (HISIC) that includes seven principles: definitions and requirements, hazard identification, safety insurance control, safety critical limits, monitoring and control, verification and validation, system log and documentation. HISIC was implemented in the development of a robot for urological applications that was known as URObot. The URObot is a universal robot with different modules adaptable for 3D ultrasound image-guided interstitial laser coagulation, radiation seed implantation, laser resection, and electrical resection of the prostate. Safety was always the key issue in the building of the robot. The HISIC strategies were adopted for safety enhancement in mechanical, electrical and software design. The initial test on URObot showed that HISIC had the potential ability to improve the safety of the system. Further safety experiments are being conducted in our laboratory.

  16. Filigree Robotics

    DEFF Research Database (Denmark)

    Tamke, Martin; Evers, Henrik Leander; Clausen Nørgaard, Esben

    2016-01-01

    Filigree Robotics experiments with the combination of traditional ceramic craft with robotic fabrication in order to generate a new narrative of fine three-dimensional ceramic ornament for architecture....

  17. Robotics in child neurosurgery.

    Science.gov (United States)

    Giorgi, C; Sala, R; Riva, D; Cossu, A; Eisenberg, H

    2000-11-01

    We felt there was a need for a new device with "minimal invasive" tracking hardware, to be used in image-guided neurosurgery, and the system we designed to fill this need is now presented. It combines precision of movement, stability and self-positioning capabilities together with optically tracked registration and procedural control within the structure of a surgical microscope. The results are reduced setup time and minimal "distraction" from the procedure itself, factors of special relevance in child neurosurgery. The system is composed of a six-axis industrial robot suitable for use in the operating room, carrying a surgical microscope. Three progressive scan-synchronized infrared cameras mounted around the lenses of the scope are used to register the patient's position and track surgical instruments with reference to the registered space. Orientation of the microscope during surgery is obtained with a six-axis joystick used as a microscope handle. The system has been clinically used in 14 cases, and it has proven itself to be reliable, providing the expected performance advantages. The implementation of a tracked ultrasound or endoscope intraoperative imaging source is also described.

  18. The role of image-guided therapy in the management of colorectal cancer metastatic disease.

    Science.gov (United States)

    de Baere, Thierry; Tselikas, Lambros; Yevich, Steven; Boige, Valérie; Deschamps, Frederic; Ducreux, Michel; Goere, Diane; Nguyen, France; Malka, David

    2017-02-23

    The European Society for Medical Oncology (ESMO) have stressed that the option for treating oligometastatic disease is a strategy of local ablative therapy, the goal of which is to improve disease control. The spectrum of the local ablative therapy toolbox described by the ESMO includes surgical R0 resection, percutaneous ablation and intra-arterial therapies, the choice of treatment being left to the multidisciplinary team. Interventional therapy involving image-guided treatment offers the possibility of less invasive treatments for colorectal cancer metastases in the liver, lung and bone by preserving from toxicity distant healthy organs or even parts of the diseased organs. Oligometastases can be targeted by image-guided puncture for percutaneous ablation by delivering locally, through inserted probes, heat (radiofrequency, microwaves), extreme cold (cryoablation) or electric pulses (electroporation). Radiofrequency (RFA) is the mainstay of percutaneous ablation and provides local control rates of around 90% when metastases are small (imaging guidance. The lung provides a specific environment with excellent visibility of the target tumour, and insulation of the tumour by the healthy lung improves thermal delivery. RFA of colorectal lung metastases provides a 5-year overall survival of 56.0%, with a 91.6% control rate for metastases with a diameter <3 cm. These results are comparable to results of surgical series. Non-resectable, non-ablatable liver metastases can be targeted through their preferential arterial vascularisation with hepatic arterial infusion chemotherapy (HAIC) or selective internal radiation therapy (SIRT) with radioactive microspheres. HAIC with oxaliplatin has demonstrated an impressive response rate when patients who have previously failed intravenous oxaliplatin are rechallenged. The response rate in first-line therapy is around 90%, with conversion to surgery in roughly 40% of patients. SIRT has recently demonstrated a benefit for

  19. SU-E-J-191: Motion Prediction Using Extreme Learning Machine in Image Guided Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Jia, J; Cao, R; Pei, X; Wang, H; Hu, L [Key Laboratory of Neutronics and Radiation Safety, Institute of Nuclear Energy Safety Technology, Chinese Academy of Sciences, Hefei, Anhui, 230031 (China); Engineering Technology Research Center of Accurate Radiotherapy of Anhui Province, Hefei 230031 (China); Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, SuZhou (China)

    2015-06-15

    Purpose: Real-time motion tracking is a critical issue in image guided radiotherapy due to the time latency caused by image processing and system response. It is of great necessity to fast and accurately predict the future position of the respiratory motion and the tumor location. Methods: The prediction of respiratory position was done based on the positioning and tracking module in ARTS-IGRT system which was developed by FDS Team (www.fds.org.cn). An approach involving with the extreme learning machine (ELM) was adopted to predict the future respiratory position as well as the tumor’s location by training the past trajectories. For the training process, a feed-forward neural network with one single hidden layer was used for the learning. First, the number of hidden nodes was figured out for the single layered feed forward network (SLFN). Then the input weights and hidden layer biases of the SLFN were randomly assigned to calculate the hidden neuron output matrix. Finally, the predicted movement were obtained by applying the output weights and compared with the actual movement. Breathing movement acquired from the external infrared markers was used to test the prediction accuracy. And the implanted marker movement for the prostate cancer was used to test the implementation of the tumor motion prediction. Results: The accuracy of the predicted motion and the actual motion was tested. Five volunteers with different breathing patterns were tested. The average prediction time was 0.281s. And the standard deviation of prediction accuracy was 0.002 for the respiratory motion and 0.001 for the tumor motion. Conclusion: The extreme learning machine method can provide an accurate and fast prediction of the respiratory motion and the tumor location and therefore can meet the requirements of real-time tumor-tracking in image guided radiotherapy.

  20. MO-E-BRD-01: Is Non-Invasive Image-Guided Breast Brachytherapy Good?

    Energy Technology Data Exchange (ETDEWEB)

    Hiatt, J. [Rhode Island Hospital (United States)

    2015-06-15

    Is Non-invasive Image-Guided Breast Brachytherapy Good? – Jess Hiatt, MS Non-invasive Image-Guided Breast Brachytherapy (NIBB) is an emerging therapy for breast boost treatments as well as Accelerated Partial Breast Irradiation (APBI) using HDR surface breast brachytherapy. NIBB allows for smaller treatment volumes while maintaining optimal target coverage. Considering the real-time image-guidance and immobilization provided by the NIBB modality, minimal margins around the target tissue are necessary. Accelerated Partial Breast Irradiation in brachytherapy: is shorter better? - Dorin Todor, PhD VCU A review of balloon and strut devices will be provided together with the origins of APBI: the interstitial multi-catheter implant. A dosimetric and radiobiological perspective will help point out the evolution in breast brachytherapy, both in terms of devices and the protocols/clinical trials under which these devices are used. Improvements in imaging, delivery modalities and convenience are among the factors driving the ultrashort fractionation schedules but our understanding of both local control and toxicities associated with various treatments is lagging. A comparison between various schedules, from a radiobiological perspective, will be given together with a critical analysis of the issues. to review and understand the evolution and development of APBI using brachytherapy methods to understand the basis and limitations of radio-biological ‘equivalence’ between fractionation schedules to review commonly used and proposed fractionation schedules Intra-operative breast brachytherapy: Is one stop shopping best?- Bruce Libby, PhD. University of Virginia A review of intraoperative breast brachytherapy will be presented, including the Targit-A and other trials that have used electronic brachytherapy. More modern approaches, in which the lumpectomy procedure is integrated into an APBI workflow, will also be discussed. Learning Objectives: To review past and current

  1. MIND Demons for MR-to-CT deformable image registration in image-guided spine surgery

    Science.gov (United States)

    Reaungamornrat, S.; De Silva, T.; Uneri, A.; Wolinsky, J.-P.; Khanna, A. J.; Kleinszig, G.; Vogt, S.; Prince, J. L.; Siewerdsen, J. H.

    2016-03-01

    Purpose: Localization of target anatomy and critical structures defined in preoperative MR images can be achieved by means of multi-modality deformable registration to intraoperative CT. We propose a symmetric diffeomorphic deformable registration algorithm incorporating a modality independent neighborhood descriptor (MIND) and a robust Huber metric for MR-to-CT registration. Method: The method, called MIND Demons, solves for the deformation field between two images by optimizing an energy functional that incorporates both the forward and inverse deformations, smoothness on the velocity fields and the diffeomorphisms, a modality-insensitive similarity function suitable to multi-modality images, and constraints on geodesics in Lagrangian coordinates. Direct optimization (without relying on an exponential map of stationary velocity fields used in conventional diffeomorphic Demons) is carried out using a Gauss-Newton method for fast convergence. Registration performance and sensitivity to registration parameters were analyzed in simulation, in phantom experiments, and clinical studies emulating application in image-guided spine surgery, and results were compared to conventional mutual information (MI) free-form deformation (FFD), local MI (LMI) FFD, and normalized MI (NMI) Demons. Result: The method yielded sub-voxel invertibility (0.006 mm) and nonsingular spatial Jacobians with capability to preserve local orientation and topology. It demonstrated improved registration accuracy in comparison to the reference methods, with mean target registration error (TRE) of 1.5 mm compared to 10.9, 2.3, and 4.6 mm for MI FFD, LMI FFD, and NMI Demons methods, respectively. Validation in clinical studies demonstrated realistic deformation with sub-voxel TRE in cases of cervical, thoracic, and lumbar spine. Conclusions: A modality-independent deformable registration method has been developed to estimate a viscoelastic diffeomorphic map between preoperative MR and intraoperative CT

  2. Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

    Directory of Open Access Journals (Sweden)

    Yazmin Yaacob

    2013-01-01

    Full Text Available Purpose: To report our early experience in image-guided chemoport insertions by interventional radiologists. Materials and Methods: This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. Results: The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%, followed by catheter-related infection (9/161; 5.6%. Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8% chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Conclusion: Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.

  3. Early Outcomes From Three Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mendenhall, Nancy P., E-mail: menden@shands.ufl.edu [University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Li Zuofeng; Hoppe, Bradford S.; Marcus, Robert B.; Mendenhall, William M.; Nichols, R. Charles; Morris, Christopher G. [University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Williams, Christopher R.; Costa, Joseph [Division of Urology, College of Medicine, University of Florida, Jacksonville, FL (United States); Henderson, Randal [University of Florida Proton Therapy Institute, Jacksonville, FL (United States)

    2012-01-01

    Purpose: To report early outcomes with image-guided proton therapy for prostate cancer. Methods and Materials: We accrued 211 prostate cancer patients on prospective Institutional Review Board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low-risk disease, dose escalation from 78 to 82 CGE for intermediate-risk disease, and 78 CGE with concomitant docetaxel followed by androgen deprivation for high-risk disease. Minimum follow-up was 2 years. Results: One intermediate-risk patient and 2 high-risk patients had disease progression. Pretreatment genitourinary (GU) symptom management was required in 38% of patients. A cumulative 88 (42%) patients required posttreatment GU symptom management. Four transient Grade 3 GU toxicities occurred, all among patients requiring pretreatment GU symptom management. Multivariate analysis showed correlation between posttreatment GU 2+ symptoms and pretreatment GU symptom management (p < 0.0001) and age (p = 0.0048). Only 1 Grade 3+ gastrointestinal (GI) symptom occurred. The prevalence of Grade 2+ GI symptoms was 0 (0%), 10 (5%), 12 (6%), and 8 (4%) at 6, 12, 18, and 24 months, with a cumulative incidence of 20 (10%) patients at 2 years after proton therapy. Univariate and multivariate analyses showed significant correlation between Grade 2+ rectal bleeding and proctitis and the percentage of rectal wall (rectum) receiving doses ranging from 40 CGE (10 CGE) to 80 CGE. Conclusions: Early outcomes with image-guided proton therapy suggest high efficacy and minimal toxicity with only 1.9% Grade 3 GU symptoms and <0.5% Grade 3 GI toxicities.

  4. Lipiodol as a Fiducial Marker for Image-Guided Radiation Therapy for Bladder Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Freilich, Jessica M.; Spiess, Philippe E.; Biagioli, Matthew C.; Fernandez, Daniel C.; Shi, Ellen J.; Hunt, Dylan C.; Gupta, Shilpa; Wilder, Richard B., E-mail: richard.wilder@moffitt.org [Moffitt Cancer Center, Tampa, FL (United States)

    2014-03-15

    Purpose: To evaluate Lipiodol as a liquid, radio-opaque fiducial marker for image-guided radiation therapy (IGRT) for bladder cancer; Materials and Methods: Between 2011 and 2012, 5 clinical T2a-T3b N0 M0 stage II-III bladder cancer patients were treated with maximal transurethral resection of a bladder tumor (TURBT) and image-guided radiation therapy (IGRT) to 64.8 Gy in 36 fractions ± concurrent weekly cisplatin-based or gemcitabine chemotherapy. Ten to 15mL Lipiodol, using 0.5mL per injection, was injected into bladder submucosa circumferentially around the entire periphery of the tumor bed immediately following maximal TURBT. The authors looked at inter-observer variability regarding the size and location of the tumor bed (CTVboost) on computed tomography scans with versus without Lipiodol. Results: Median follow-up was 18 months. Lipiodol was visible on every orthogonal two-dimensional kV portal image throughout the entire, 7-week course of IGRT. There was a trend towards improved inter-observer agreement on the CTVboost with Lipiodol (p = 0.06). In 2 of 5 patients, the tumor bed based upon Lipiodol extended outside a planning target volume that would have been treated with a radiation boost based upon a cystoscopy report and an enhanced computed tomography (CT) scan for staging. There was no toxicity attributable to Lipiodol: Conclusions: Lipiodol constitutes a safe and effective fiducial marker that an urologist can use to demarcate a tumor bed immediately following maximal TURBT. Lipiodol decreases inter-observer variability in the definition of the extent and location of a tumor bed on a treatment planning CT scan for a radiation boost. (author)

  5. Image-guided cold atmosphere plasma (CAP) therapy for cutaneous wound

    Science.gov (United States)

    Yu, Zelin; Ren, Wenqi; Gan, Qi; Li, Jiahong; Li, XiangXiang; Zhang, Shiwu; Jin, Fan; Cheng, Cheng; Ting, Yue; Xu, Ronald X.

    2016-03-01

    Bacterial infection is one of the major factors contributing to the compromised healing in chronic wounds. Sometimes bacteria biofilms formed on the wound are more resistant than adherent bacteria. Cold atmosphere plasma (CAP) has already shown its potential in contact-free disinfection, blood coagulation, and wound healing. In this study, we integrated a multimodal imaging system with a portable CAP device for image-guided treatment of infected wound in vivo and evaluated the antimicrobial effect on Pseudomonas aeruginosa sample in vitro.15 ICR mice were divided into three groups for therapeutic experiments:(1) control group with no infection nor treatment (2) infection group without treatment (3) infection group with treatment. For each mouse, a three millimeters punch biopsy was created on the dorsal skin. Infection was induced by Staphylococcus aureus inoculation one day post-wounding. The treated group was subjected to CAP for 2 min daily till day 13. For each group, five fixed wounds' oxygenation and blood perfusion were evaluated daily till day 13 by a multimodal imaging system that integrates a multispectral imaging module and a laser speckle imaging module. In the research of relationship between therapeutic depth and sterilization effect on P.aeruginosa in agarose, we found that the CAP-generated reactive species reached the depth of 26.7μm at 30s and 41.6μm at 60s for anti-bacterial effects. Image-guided CAP therapy can be potentially used to control infection and facilitate the healing process of infected wounds.

  6. Visualization of risk structures for interactive planning of image guided radiofrequency ablation of liver tumors

    Science.gov (United States)

    Rieder, Christian; Schwier, Michael; Weihusen, Andreas; Zidowitz, Stephan; Peitgen, Heinz-Otto

    2009-02-01

    Image guided radiofrequency ablation (RFA) is becoming a standard procedure as a minimally invasive method for tumor treatment in the clinical routine. The visualization of pathological tissue and potential risk structures like vessels or important organs gives essential support in image guided pre-interventional RFA planning. In this work our aim is to present novel visualization techniques for interactive RFA planning to support the physician with spatial information of pathological structures as well as the finding of trajectories without harming vitally important tissue. Furthermore, we illustrate three-dimensional applicator models of different manufactures combined with corresponding ablation areas in homogenous tissue, as specified by the manufacturers, to enhance the estimated amount of cell destruction caused by ablation. The visualization techniques are embedded in a workflow oriented application, designed for the use in the clinical routine. To allow a high-quality volume rendering we integrated a visualization method using the fuzzy c-means algorithm. This method automatically defines a transfer function for volume visualization of vessels without the need of a segmentation mask. However, insufficient visualization results of the displayed vessels caused by low data quality can be improved using local vessel segmentation in the vicinity of the lesion. We also provide an interactive segmentation technique of liver tumors for the volumetric measurement and for the visualization of pathological tissue combined with anatomical structures. In order to support coagulation estimation with respect to the heat-sink effect of the cooling blood flow which decreases thermal ablation, a numerical simulation of the heat distribution is provided.

  7. Lipiodol as a Fiducial Marker for Image-Guided Radiation Therapy for Bladder Cancer

    Directory of Open Access Journals (Sweden)

    Jessica M. Freilich

    2014-04-01

    Full Text Available Purpose To evaluate Lipiodol as a liquid, radio-opaque fiducial marker for image-guided radiation therapy (IGRT for bladder cancer.Materials and Methods Between 2011 and 2012, 5 clinical T2a-T3b N0 M0 stage II-III bladder cancer patients were treated with maximal transurethral resection of a bladder tumor (TURBT and image-guided radiation therapy (IGRT to 64.8 Gy in 36 fractions ± concurrent weekly cisplatin-based or gemcitabine chemotherapy. Ten to 15mL Lipiodol, using 0.5mL per injection, was injected into bladder submucosa circumferentially around the entire periphery of the tumor bed immediately following maximal TURBT. The authors looked at inter-observer variability regarding the size and location of the tumor bed (CTVboost on computed tomography scans with versus without Lipiodol.Results Median follow-up was 18 months. Lipiodol was visible on every orthogonal two-dimensional kV portal image throughout the entire, 7-week course of IGRT. There was a trend towards improved inter-observer agreement on the CTVboost with Lipiodol (p = 0.06. In 2 of 5 patients, the tumor bed based upon Lipiodol extended outside a planning target volume that would have been treated with a radiation boost based upon a cystoscopy report and an enhanced computed tomography (CT scan for staging. There was no toxicity attributable to Lipiodol.Conclusions Lipiodol constitutes a safe and effective fiducial marker that an urologist can use to demarcate a tumor bed immediately following maximal TURBT. Lipiodol decreases inter-observer variability in the definition of the extent and location of a tumor bed on a treatment planning CT scan for a radiation boost.

  8. A Low-Cost, Passive Navigation Training System for Image-Guided Spinal Intervention.

    Science.gov (United States)

    Lorias-Espinoza, Daniel; Carranza, Vicente González; de León, Fernando Chico-Ponce; Escamirosa, Fernando Pérez; Martinez, Arturo Minor

    2016-11-01

    Navigation technology is used for training in various medical specialties, not least image-guided spinal interventions. Navigation practice is an important educational component that allows residents to understand how surgical instruments interact with complex anatomy and to learn basic surgical skills such as the tridimensional mental interpretation of bidimensional data. Inexpensive surgical simulators for spinal surgery, however, are lacking. We therefore designed a low-cost spinal surgery simulator (Spine MovDigSys 01) to allow 3-dimensional navigation via 2-dimensional images without altering or limiting the surgeon's natural movement. A training system was developed with an anatomical lumbar model and 2 webcams to passively digitize surgical instruments under MATLAB software control. A proof-of-concept recognition task (vertebral body cannulation) and a pilot test of the system with 12 neuro- and orthopedic surgeons were performed to obtain feedback on the system. Position, orientation, and kinematic variables were determined and the lateral, posteroanterior, and anteroposterior views obtained. The system was tested with a proof-of-concept experimental task. Operator metrics including time of execution (t), intracorporeal length (d), insertion angle (α), average speed (v¯), and acceleration (a) were obtained accurately. These metrics were converted into assessment metrics such as smoothness of operation and linearity of insertion. Results from initial testing are shown and the system advantages and disadvantages described. This low-cost spinal surgery training system digitized the position and orientation of the instruments and allowed image-guided navigation, the generation of metrics, and graphic recording of the instrumental route. Spine MovDigSys 01 is useful for development of basic, noninnate skills and allows the novice apprentice to quickly and economically move beyond the basics. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Army Robotics

    Science.gov (United States)

    2009-10-07

    Army Robotics 07 October 2009 Dr. Grant Gerhart, Senior Research Scientist Bernard Theisen, Joint Center for Robotics DISTRIBUTION STATEMENT A... Robots 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Grant Gerhart; Bernard Theisen 5d. PROJECT NUMBER 5e. TASK...CBRNE • IED Defeat Systems • Disarm / Disrupt • Reconnaissance • Investigation • Explosive Sniffer • Common Robotic Kit • EOD • Convoy • Log

  10. TARDEC Robotics

    Science.gov (United States)

    2010-01-12

    unclassified TARDEC Robotics Dr. James L. Overholt Director, Joint Center for Robotics US Army TARDEC Report Documentation Page Form ApprovedOMB No...COVERED - 4. TITLE AND SUBTITLE TARDEC Robotics 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) James L. Overholt... Robotics , Network and Control Components with a Focus on Customer Driven Requirements to Provide Full System Solutions to the War Fighter Technology

  11. Robot Futures

    DEFF Research Database (Denmark)

    Christoffersen, Anja; Grindsted Nielsen, Sally; Jochum, Elizabeth Ann;

    Robots are increasingly used in health care settings, e.g., as homecare assistants and personal companions. One challenge for personal robots in the home is acceptance. We describe an innovative approach to influencing the acceptance of care robots using theatrical performance. Live performance i...... perceive social robots interacting with humans in a future care scenario through a scripted performance. We discuss our methods and initial findings, and outline future work....

  12. Mobile robots

    Energy Technology Data Exchange (ETDEWEB)

    Wolfe, W.J.; Marquina, N.

    1986-01-01

    This book presents papers given at a conference on mobile robots. Topics the conference included are the following: mobility systems for robotic vehicles; detection and control of mobile robot motion by real-time computer vision, obstacle avoidance algorithms for an autonomous land vehicle; hierarchical processor and matched filters for range image processing; asynchronous distributed control system for a mobile robot, and, planning in a hierarchical nested autonomous control system.

  13. Principles and advantages of robotics in urologic surgery.

    Science.gov (United States)

    Renda, Antonio; Vallancien, Guy

    2003-04-01

    Although the available minimally invasive surgical techniques (ie, laparoscopy) have clear advantages, these procedures continue to cause problems for patients. Surgical tools are limited by set axes of movement, restricting the degree of freedom available to the surgeon. In addition, depth perception is lost with the use of two-dimensional viewing systems. As surgeons view a "virtual" target on a television screen, they are hampered by decreased sensory input and a concurrent loss of dexterity. The development of robotic assistance systems in recent years could be the key to overcoming these difficulties. Using robotic systems, surgeons can experience a more natural and ergonomic surgical "feel." Surgical assistance, dexterity and precision enhancement, systems networking, and image-guided therapy are among the benefits offered by surgical robots. In return, the surgeon gains a shorter learning curve, reduced fatigue, and the opportunity to perform complex procedures that would be difficult using conventional laparoscopy. With the development of image-guided technology, robotic systems will become useful tools for surgical training and simulation. Remote surgery is not a routine procedure, but several teams are working on this and experiencing good results. However, economic concerns are the major drawbacks of these systems; before remote surgery becomes routinely feasible, the clinical benefits must be balanced with high investment and running costs.

  14. SU-E-T-642: Safety Procedures for Error Elimination in Cyberknife Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

    Energy Technology Data Exchange (ETDEWEB)

    Hussain, A; Alkafi, A; Al-Najjar, W; Moftah, B [King Faisal Specialist Hospital and Research Center, Department of Biomedical Physics, Riyadh (Saudi Arabia)

    2014-06-15

    Purpose: Cyberknife system is used for providing stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) hypofractionation scheme. The whole treatment delivery is based on live imaging of the patient. The minor error made at any stage may bring severe radiation injury to the patient or damage to the system itself. Several safety measures were taken to make the system safer. Methods: The radiation treatment provided thru a 6MV linac attached to Kuka robot (Cyberknife G4, Accuray Inc. Sunnyvale, CA, USA). Several possible errors were identified related to patient alignment, treatment planning, dose delivery and physics quality assurance. During dose delivery, manual and visual checks were introduced to confirm pre and intra-treatment imaging to reduce possible errors. One additional step was introduced to confirm that software tracking-tools had worked correctly with highest possible confidence level. Robotic head move in different orientations over and around the patient body, the rigidity of linac-head cover and other accessories was checked periodically. The vender was alerted when a tiny or bigger piece of equipment needed additional interlocked support. Results: As of our experience treating 525 patients on Cyberknife during the last four years, we saw on and off technical issues. During image acquisition, it was made essential to follow the site-specific imaging protocols. Adequate anatomy was contoured to document the respective doses. Followed by auto-segmentation, manual tweaking was performed on every structure. The calculation box was enclosing the whole image during the final calculation. Every plan was evaluated on slice-by slice basis. To review the whole process, a check list was maintained during the physics 2nd-check. Conclusion: The implementation of manual and visual additional checks introduced along with automated checks for confirmation was found promising in terms of reduction in systematic errors and making the system

  15. Hounsfield unit recovery in clinical cone beam CT images of the thorax acquired for image guided radiation therapy

    DEFF Research Database (Denmark)

    Thing, Rune Slot; Bernchou, Uffe; Mainegra-Hing, Ernesto

    2016-01-01

    A comprehensive artefact correction method for clinical cone beam CT (CBCT) images acquired for image guided radiation therapy (IGRT) on a commercial system is presented. The method is demonstrated to reduce artefacts and recover CT-like Hounsfield units (HU) in reconstructed CBCT images of five ...

  16. A review of treatment planning for precision image-guided photon beam pre-clinical animal radiation studies

    NARCIS (Netherlands)

    Verhaegen, Frank; van Hoof, Stefan; Granton, Patrick V; Trani, Daniela

    2014-01-01

    Recently, precision irradiators integrated with a high-resolution CT imaging device became available for pre-clinical studies. These research platforms offer significant advantages over older generations of animal irradiators in terms of precision and accuracy of image-guided radiation targeting. Th

  17. The using of megavoltage computed tomography in image-guided brachytherapy for cervical cancer: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Tharavichitkul, Ekkasit; Janla-or, Suwapim; Wanwilairat, Somsak; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Supawongwattana, Bongkot; Chitapanarux, Imjai [Division of Therapeutic Radiology and Oncology, Dept. of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai (Thailand); Galalae, Razvan M. [Faculty of Medicine, Christian-Albrecht University (Campus Kiel), Kiel (Germany)

    2015-06-15

    We present a case of cervical cancer treated by concurrent chemoradiation. In radiation therapy part, the combination of the whole pelvic helical tomotherapy plus image-guided brachytherapy with megavoltage computed tomography of helical tomotherapy was performed. We propose this therapeutic approach could be considered in a curative setting in some problematic situation as our institution.

  18. Theranostics based on Iron Oxide and Gold Nanoparticles for Imaging-Guided Photothermal and Photodynamic Therapy of Cancer.

    Science.gov (United States)

    Rajkumar, S; Prabaharan, M

    2016-11-22

    With the progress of nanotechnology, the treatment of cancer by photothermal therapy (PTT) and photodynamic therapy (PDT) using theranostic nanomaterials based on iron oxide (Fe3O4) and gold (Au) nanoparticles (NPs) has received much attention in recent years. The Fe3O4 NPs have been used as imaging-guided PTT of cancer due to their high relaxivity, excellent contrast enhancement, and less toxicity. The Au NPs have been widely employed as a contrast agent for CT imaging of different biological systems due to their enhanced X-ray attenuation property. Due to the strong surface plasmon resonance (SPR) absorption intensity in near-infrared (NIR) region, Au NPs have been considered for imaging-guided PTT of cancer. Since the photosensitizer, which plays an important role in PDT of cancer, can be efficiently conjugated with Fe3O4 and Au NPs, these NPs have also been considered for imaging-guided PDT of cancer. It has been found that both Fe3O4 and Au NPs allow passive targeting of tumors through enhanced permeability and retention (EPR) effect to improve the treatment efficacy in PTT and PDT. The present review focuses on the recent developments of Fe3O4 and Au-based NPs as theranostics for imaging-guided PTT and PDT of cancer.

  19. Image guided adaptive brachytherapy for cervical cancer: Dose contribution to involved pelvic nodes in two cancer centers

    NARCIS (Netherlands)

    W. van den Bos (Willemien); S. Beriwal (Sushil); L. Velema (Laura); A.A.C. de Leeuw (Astrid A.); C.N. Nomden (Christel); I.-M. Jürgenliemk-Schulz (Ina-M.)

    2014-01-01

    textabstractPurpose: The goal of this study was to determine the dose contributions from image guided adaptive brachytherapy (IGABT) to individual suspicious pelvic lymph nodes (pLNN) in cervical cancer patients. Data were collected in two cancer centers, University of Pittsburgh Cancer Institute

  20. Toxic risk of stereotactic body radiotherapy and concurrent helical tomotherapy followed by erlotinib for non-small-cell lung cancer treatment - case report

    Directory of Open Access Journals (Sweden)

    Chen Chien-An

    2010-12-01

    Full Text Available Abstract Background Stereotactic body radiation therapy (SBRT applied by helical tomotherapy (HT is feasible for lung cancer in clinical. Using SBRT concurrently with erlotinib for non-small cell lung cancer (NSCLC is not reported previously. Case Presentation A 77-year-old man with stage III NSCLC, received erlotinib 150 mg/day, combined with image-guided SBRT via HT. A total tumor dose of 54 Gy/9 fractions was delivered to the tumor bed. The tumor responded dramatically and the combined regimen was well tolerated. After concurrent erlotinib-SBRT, erlotinib was continued as maintenance therapy. The patient developed dyspnea three months after the combined therapy and radiation pneumonitis with interstitial lung disease was suspected. Conclusions Combination SBRT, HT, and erlotinib therapy provided effective anti-tumor results. Nonetheless, the potential risks of enhanced adverse effects between radiation and erlotinib should be monitored closely, especially when SBRT is part of the regimen.

  1. Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours.

    Science.gov (United States)

    Arcangeli, Stefano; Falcinelli, Lorenzo; Bracci, Stefano; Greco, Alessandro; Monaco, Alessia; Dognini, Jessica; Chiostrini, Cinzia; Bellavita, Rita; Aristei, Cynthia; Donato, Vittorio

    2017-03-01

    To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions. 68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume. 52% of the lesions received a biological equivalent dose (BED10) ≥100 Gy. Assessment of tumour response was based on the Response Evaluation Criteria in Solid Tumours 1.1 criteria coupled with fluorine-18 fludeoxyglucose/positron emission tomography-CT. Toxicity monitoring was focused on treatment-related pulmonary adverse events according to the Common Terminology Criteria for Adverse Events v. 4.0. Acute and late events were classified as radiation pneumonitis (RP) and radiation fibrosis (RF), respectively. Survival curves were calculated using the Kaplan-Meier method. Univariate and multivariate analyses of survival were performed using the Cox proportional hazards model. After a median follow-up of 12 months (range, 3-31 months), no instances of ≥Grade 4 RP was documented, and clinically severe (Grade 3) RP occurred in 5.8% of the patients. 2 (3%) patients developed a late severe (≥Grade 3) symptomatic RF. No specific pattern of CT lung injury was demonstrated, in both acute and late settings. Median overall survival (OS) and progression-free survival (PFS) for the entire population were 30.8 and 14.1 months, respectively. At multivariate analysis (MVA), BED10 ≥ 100 Gy and KPS ≥ 90 emerged as significant prognostic factors for OS (p = 0.01 and p = 0.001, respectively), and BED10 ≥ 100 Gy for PFS (p = 0.02). Our findings show that HHT adjusted for tumour location and/or target volume is an effective treatment with an acceptable toxicity profile in patients who are medically inoperable with lung tumours and is not

  2. Robot Mechanisms

    CERN Document Server

    Lenarcic, Jadran; Stanišić, Michael M

    2013-01-01

    This book provides a comprehensive introduction to the area of robot mechanisms, primarily considering industrial manipulators and humanoid arms. The book is intended for both teaching and self-study. Emphasis is given to the fundamentals of kinematic analysis and the design of robot mechanisms. The coverage of topics is untypical. The focus is on robot kinematics. The book creates a balance between theoretical and practical aspects in the development and application of robot mechanisms, and includes the latest achievements and trends in robot science and technology.

  3. Robotic mitral valve surgery.

    Science.gov (United States)

    Kypson, Alan P; Nifong, L Wiley; Chitwood, W Randolph

    2003-12-01

    placement of an atrial retractor, as well as needle, tissue, and suture retrieval. With the development of specialized retractors and a delivery/retrieval port, a truly endoscopic approach will be consistently reproducible. New navigation systems and image guided surgery portend an improving future for robotic cardiac surgery. Recently, we have combined robotically guided microwave catheters for ablation of atrial fibrillation with robotic mitral valve repairs (Fig. 8). Thus, we are beginning to achieve the ideal operation, with a native valve repair and a return to normal sinus rhythm. Robotic cardiac surgery is an evolutionary process, and even the greatest skeptics must concede that progress has been made toward endoscopic cardiac valve operations. Surgical scientists must continue to critically evaluate this technology in this new era of cardiac surgery. Despite enthusiasm, caution cannot be overemphasized. Surgeons must be careful because indices of operative safety, speed of recovery, level of discomfort, procedural cost, and long-term operative quality have yet to be defined. Traditional valve operations still enjoy long-term success with ever-decreasing morbidity and mortality, and remain our measure for comparison. Surgeons must remember that we are seeking the most durable operation with the least human trauma and quickest return to normalcy, all done at the lowest cost with the least risks. Although we have moved more asymptotically to these goals, surgeons alone must map the path for the final ascent.

  4. Robot Futures

    DEFF Research Database (Denmark)

    Christoffersen, Anja; Grindsted Nielsen, Sally; Jochum, Elizabeth Ann

    Robots are increasingly used in health care settings, e.g., as homecare assistants and personal companions. One challenge for personal robots in the home is acceptance. We describe an innovative approach to influencing the acceptance of care robots using theatrical performance. Live performance...... is a useful testbed for developing and evaluating what makes robots expressive; it is also a useful platform for designing robot behaviors and dialogue that result in believable characters. Therefore theatre is a valuable testbed for studying human-robot interaction (HRI). We investigate how audiences...... perceive social robots interacting with humans in a future care scenario through a scripted performance. We discuss our methods and initial findings, and outline future work....

  5. Stereotactic radiosurgery for multiple brain metastases

    Science.gov (United States)

    Lee, Anna; (Josh Yamada, Yoshiya

    2017-01-01

    Whole brain radiation therapy has been the traditional treatment of choice for patients with multiple brain metastases. Although stereotactic radiosurgery is widely accepted for the management to up to 4 brain metastases, its use is still controversial in cases of 5 or more brain metastases. Randomized trials have suggested that stereotactic radiosurgery alone is appropriate in up to 4 metastases without concomitant whole brain radiation. Level 1 evidence also suggests that withholding whole brain radiation may also reduce the impact of radiation on neurocognitive function and also may even offer a survival advantage. A recent analysis of a large multicentre prospective database has suggested that there are no differences in outcomes such as the likelihood of new metastasis or leptomeningeal disease in cases of 2-10 brain metastases, nor in overall survival. Hence in the era of prolonged survival with stage IV cancer, stereotactic radiosurgery is a reasonable alternative to whole brain radiation in order to minimize the impact of treatment upon quality of life without sacrificing overall survival.

  6. Stereotactic Radiosurgery and Fractionated Stereotactic Radiation Therapy for the Treatment of Uveal Melanoma.

    Science.gov (United States)

    Yazici, Gozde; Kiratli, Hayyam; Ozyigit, Gokhan; Sari, Sezin Yuce; Cengiz, Mustafa; Tarlan, Bercin; Mocan, Burce Ozgen; Zorlu, Faruk

    2017-05-01

    To evaluate treatment results of stereotactic radiosurgery or fractionated stereotactic radiation therapy (SRS/FSRT) for uveal melanoma. We retrospectively evaluated 181 patients with 182 uveal melanomas receiving SRS/FSRT between 2007 and 2013. Treatment was administered with CyberKnife. According to Collaborative Ocular Melanoma Study criteria, tumor size was small in 1%, medium in 49.5%, and large in 49.5% of the patients. Seventy-one tumors received treatment outcome was achieved using ≥45 Gy in 3 fractions. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Compensating for Quasi-periodic Motion in Robotic Radiosurgery

    CERN Document Server

    Ernst, Floris

    2012-01-01

    Compensating for Quasi-periodic Motion in Robotic Radiosurgery outlines the techniques needed to accurately track and compensate for respiratory and pulsatory motion during robotic radiosurgery. The algorithms presented within the book aid in the treatment of tumors that move during respiration. In Chapters 1 and 2,  the book introduces the concept of stereotactic body radiation therapy, motion compensation strategies and the clinical state-of-the-art. In Chapters 3 through 5, the author describes and evaluates new methods for motion prediction, for correlating external motion to internal organ motion, and for the evaluation of these algorithms’ output based on an unprecedented amount of real clinical data. Finally, Chapter 6 provides a brief introduction into currently investigated, open questions and further fields of research. Compensating for Quasi-periodic Motion in Robotic Radiosurgery targets researchers working in the related fields of surgical oncology, artificial intelligence, robotics and more. ...

  8. Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy.

    Science.gov (United States)

    Su, Hao; Shang, Weijian; Cole, Gregory; Li, Gang; Harrington, Kevin; Camilo, Alexander; Tokuda, Junichi; Tempany, Clare M; Hata, Nobuhiko; Fischer, Gregory S

    2015-08-01

    This paper presents a fully-actuated robotic system for percutaneous prostate therapy under continuously acquired live magnetic resonance imaging (MRI) guidance. The system is composed of modular hardware and software to support the surgical workflow of intra-operative MRI-guided surgical procedures. We present the development of a 6-degree-of-freedom (DOF) needle placement robot for transperineal prostate interventions. The robot consists of a 3-DOF needle driver module and a 3-DOF Cartesian motion module. The needle driver provides needle cannula translation and rotation (2-DOF) and stylet translation (1-DOF). A custom robot controller consisting of multiple piezoelectric motor drivers provides precision closed-loop control of piezoelectric motors and enables simultaneous robot motion and MR imaging. The developed modular robot control interface software performs image-based registration, kinematics calculation, and exchanges robot commands and coordinates between the navigation software and the robot controller with a new implementation of the open network communication protocol OpenIGTLink. Comprehensive compatibility of the robot is evaluated inside a 3-Tesla MRI scanner using standard imaging sequences and the signal-to-noise ratio (SNR) loss is limited to 15%. The image deterioration due to the present and motion of robot demonstrates unobservable image interference. Twenty-five targeted needle placements inside gelatin phantoms utilizing an 18-gauge ceramic needle demonstrated 0.87 mm root mean square (RMS) error in 3D Euclidean distance based on MRI volume segmentation of the image-guided robotic needle placement procedure.

  9. The Mobius AIRO mobile CT for image-guided proton therapy: Characterization & commissioning.

    Science.gov (United States)

    Oliver, Jasmine A; Zeidan, Omar A; Meeks, Sanford L; Shah, Amish P; Pukala, Jason; Kelly, Patrick; Ramakrishna, Naren R; Willoughby, Twyla R

    2017-05-01

    The purpose of this study was to characterize the Mobius AIRO Mobile CT System for localization and image-guided proton therapy. This is the first known application of the AIRO for proton therapy. Five CT images of a Catphan(®) 504 phantom were acquired on the AIRO Mobile CT System, Varian EDGE radiosurgery system cone beam CT (CBCT), Philips Brilliance Big Bore 16 slice CT simulator, and Siemens SOMATOM Definition AS 20 slice CT simulator. DoseLAB software v.6.6 was utilized for image quality analysis. Modulation transfer function, scaling discrepancy, geometric distortion, spatial resolution, overall uniformity, minimum uniformity, contrast, high CNR, and maximum HU deviation were acquired. Low CNR was acquired manually using the CTP515 module. Localization accuracy and CT Dose Index were measured and compared to reported values on each imaging device. For treatment delivery systems (Edge and Mevion), the localization accuracy of the 3D imaging systems were compared to 2D imaging systems on each system. The AIRO spatial resolution was 0.21 lp mm(-1) compared with 0.40 lp mm(-1) for the Philips CT Simulator, 0.37 lp mm(-1) for the Edge CBCT, and 0.35 lp mm(-1) for the Siemens CT Simulator. AIRO/Siemens and AIRO/Philips differences exceeded 100% for scaling discrepancy (191.2% and 145.8%). The AIRO exhibited higher dose (>27 mGy) than the Philips CT Simulator. Localization accuracy (based on the MIMI phantom) was 0.6° and 0.5 mm. Localization accuracy (based on Stereophan) demonstrated maximum AIRO-kV/kV shift differences of 0.1 mm in the x-direction, 0.1 mm in the y-direction, and 0.2 mm in the z-direction. The localization accuracy of AIRO was determined to be within 0.6° and 0.5 mm despite its slightly lower image quality overall compared to other CT imaging systems at our institution. Based on our study, the Mobile AIRO CT system can be utilized accurately and reliably for image-guided proton therapy. © 2017 The Authors. Journal of Applied Clinical Medical

  10. Toward four-dimensional image-guided adaptive brachytherapy in locally recurrent endometrial cancer.

    Science.gov (United States)

    Fokdal, Lars; Ørtoft, Gitte; Hansen, Estrid S; Røhl, Lisbeth; Pedersen, Erik Morre; Tanderup, Kari; Lindegaard, Jacob Christian

    2014-01-01

    To evaluate clinical outcome and feasibility of a four-dimensional image-guided adaptive brachytherapy concept in patients with locally recurrent endometrial cancer. Forty-three patients with locally recurrent endometrial cancer were included. Treatment consisted of conformal external beam radiotherapy followed by a boost using pulsed-dose-rate brachytherapy (BT). Large tumors were treated with MRI-guided interstitial BT. Small tumors were treated with CT-guided intracavitary BT. The planning aim (total external beam radiotherapy and BT) for high-risk clinical target volume was D90 > 80 Gy, whereas constraints for organs at risk were D2cc ≤ 90 Gy for bladder and D2cc ≤ 70 Gy for rectum, sigmoid, and bowel in terms of equivalent dose in 2 Gy fractions. Median high-risk clinical target volume was 18 cm(3) (range, 0-91). D90 was 82 Gy (range, 77-88). D2cc to bladder, rectum, and sigmoid were 67 Gy (range, 50-81), 67 Gy (range, 51-77), and 55 Gy (range, 44-68), respectively. Median followup was 30 months (6-88). Two-year local control rate was 92% (standard error [SE], 5). Disease-free survival rate and overall survival rate was 59% (SE, 8) and 78% (SE, 7), respectively. Patients with low- to intermediate-risk for recurrence had a 2-year disease-free survival rate of 72% (SE, 9) compared with 42% (SE, 12) in patients with high risk for recurrence (p = 0.04). Late morbidity Grade 3 was recorded in 5 (12%) patients. Four-dimensional image-guided adaptive brachytherapy is feasible in locally recurrent endometrial cancer. Local control rate is good. Systemic control remains a problem in patients with high risk for recurrence. Copyright © 2014 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  11. Phase II Evaluation of Magnetic Resonance Imaging Guided Focal Laser Ablation of Prostate Cancer.

    Science.gov (United States)

    Eggener, Scott E; Yousuf, Ambereen; Watson, Sydeaka; Wang, Shiyang; Oto, Aytekin

    2016-12-01

    Magnetic resonance imaging guided focal laser ablation is an investigational strategy for the treatment of prostate cancer. This phase II evaluation of focal laser ablation included men with stage T1c-T2a, prostate specific antigen less than 15 ng/ml or prostate specific antigen density less than 0.15 ng/ml(3), Gleason 7 or less in 25% or less of biopsies and magnetic resonance imaging with 1 or 2 lesions concordant with biopsy detected cancer. At 3 months all patients underwent magnetic resonance imaging with biopsy of ablation zone(s). At 12 months all underwent magnetic resonance imaging and systematic biopsy. I-PSS (International Prostate Symptom Score) and SHIM (Sexual Health Inventory for Men) scores were collected before focal laser ablation, and at 1, 3 and 12 months. The primary end point was no cancer on the 3-month ablation zone biopsy. Secondary end points were safety, 12-month biopsy, and urinary and sexual function. In the 27 men median age was 62 years and mean prostate specific antigen was 4.4 ng/ml. Biopsy Gleason score was 6 in 23 patients (85%) and Gleason 7 in 4 (15%). Seven men (26%) had low volume Gleason 6 disease outside the intended ablation zone(s). At 3 months 26 patients (96%) had no evidence of cancer on magnetic resonance imaging guided biopsy of the ablation zone. No significant I-PSS changes were observed (each p >0.05). SHIM was lower at 1 month (p = 0.03), marginally lower at 3 months (p = 0.05) and without a significant difference at 12 months (p = 0.38). At 12-month biopsy cancer was identified in 10 patients (37%), including in the ablation zone(s) in 3 (11%) and outside the ablation zone(s) in 8 (30%) with cancer in and outside the ablation zone in 1. In select men with localized prostate cancer and visible magnetic resonance imaging lesions focal laser ablation has an acceptable morbidity profile and is associated with encouraging short-term oncologic outcomes. Significantly longer followup is mandatory to fully assess this

  12. The Investigation Image-guided Radiation Therapy of Bladder Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Seong Soo; Bae, Sun Myung; Kim, Jin San; Kang, Tae Young; Back, Geum Mun; Kwon, Kyung Tae [Dept. of Radiation Oncology, Asan Medical Center, Seoul (Korea, Republic of)

    2012-03-15

    In hospital image-guided radiation therapy in patients with bladder cancer to enhance the reproducibility of the appropriate amount, depending on the patient's condition, and image-guided injection of saline system (On-Board Imager system, OBI, VARIAN, USA) three of the Cone-Beam CT dimensional matching (3D-3D matching) to be the treatment. In this study, the treatment of patients with bladder cancer at Cone-Beam CT image obtained through the analysis of the bones based matching and matching based on the bladder to learn about the differences, the bladder's volume change injected saline solution by looking at the bladder for the treatment of patients with a more appropriate image matching is to assess how the discussion. At our hospital from January 2009 to April 2010 admitted for radiation therapy patients, 7 patients with bladder cancer using a Folly catheter of residual urine in the bladder after removing the amount determined according to individual patient enough to inject saline CT-Sim was designed after the treatment plan. After that, using OBI before treatment to confirm position with Cone-Beam CT scan was physician in charge of matching was performed in all patients. CBCT images using a total of 45 bones, bladder, based on image matching and image matching based on the difference were analyzed. In addition, changes in bladder volume of Eclipse (version 8.0, VARIAN, USA) persuaded through. Bones, one based image matching based on the bladder and re-matching the X axis is the difference between the average 3{+-}2 mm, Y axis, 1.8{+-}1.3 mm, Z-axis travel distance is 2.3{+-}1.7 mm and the overall 4.8{+-}2.0 mm, respectively. The volume of the bladder compared to the baseline showed a difference of 4.03{+-}3.97%. Anatomical location and nature of the bladder due to internal movement of the bones, even after matching with the image of the bladder occurred in different locations. In addition, the volume of saline-filled bladder showed up the difference

  13. Protein-based photothermal theranostics for imaging-guided cancer therapy

    Science.gov (United States)

    Rong, Pengfei; Huang, Peng; Liu, Zhiguo; Lin, Jing; Jin, Albert; Ma, Ying; Niu, Gang; Yu, Lun; Zeng, Wenbin; Wang, Wei; Chen, Xiaoyuan

    2015-10-01

    The development of imageable photothermal theranostics has attracted considerable attention for imaging guided photothermal therapy (PTT) with high tumor ablation accuracy. In this study, we strategically constructed a near-infrared (NIR) cyanine dye by introducing a rigid cyclohexenyl ring to the heptamethine chain to obtain a heptamethine dye CySCOOH with high fluorescence intensity and good stability. By covalent conjugation of CySCOOH onto human serum albumin (HSA), the as-prepared HSA@CySCOOH nanoplatform is highly efficient for NIR fluorescence/photoacoustic/thermal multimodality imaging and photothermal tumor ablation. The theranostic capability of HSA@CySCOOH was systematically evaluated both in vitro and in vivo. Most intriguingly, complete tumor elimination was achieved by intravenous injection of HSA@CySCOOH (CySCOOH, 1 mg kg-1 808 nm, 1.0 W cm-2 for 5 min) into 4T1 tumor-bearing mice, with no weight loss, noticeable toxicity, or tumor recurrence being observed. This as-prepared protein-based nanotheranostics exhibits high water dispersibility, no off target cytotoxicity, and good biodegradability and biocompatibility, thus facilitating its clinical translation to cancer photothermal theranostics.The development of imageable photothermal theranostics has attracted considerable attention for imaging guided photothermal therapy (PTT) with high tumor ablation accuracy. In this study, we strategically constructed a near-infrared (NIR) cyanine dye by introducing a rigid cyclohexenyl ring to the heptamethine chain to obtain a heptamethine dye CySCOOH with high fluorescence intensity and good stability. By covalent conjugation of CySCOOH onto human serum albumin (HSA), the as-prepared HSA@CySCOOH nanoplatform is highly efficient for NIR fluorescence/photoacoustic/thermal multimodality imaging and photothermal tumor ablation. The theranostic capability of HSA@CySCOOH was systematically evaluated both in vitro and in vivo. Most intriguingly, complete tumor

  14. Dual-mode ultrasound arrays for image-guided targeting of atheromatous plaques

    Science.gov (United States)

    Ballard, John R.; Casper, Andrew J.; Liu, Dalong; Haritonova, Alyona; Shehata, Islam A.; Troutman, Mitchell; Ebbini, Emad S.

    2012-11-01

    A feasibility study was undertaken in order to investigate alternative noninvasive treatment options for atherosclerosis. In particular, the aim of this study was to investigate the potential use of Dual-Mode Ultrasound Arrays (DMUAs) for image guided treatment of atheromatous plaques. DMUAs offer a unique treatment paradigm for image-guided surgery allowing for robust image-based identification of tissue targets for localized application of HIFU. In this study we present imaging and therapeutic results form a 3.5 MHz, 64-element fenestrated prototype DMUA for targeting lesions in the femoral artery of familial hypercholesterolemic (FH) swine. Before treatment, diagnostic ultrasound was used to verify the presence of plaque in the femoral artery of the swine. Images obtained with the DMUA and a diagnostic (HST 15-8) transducer housed in the fenestration were analyzed and used for guidance in targeting of the plaque. Discrete therapeutic shots with an estimated focal intensity of 4000-5600 W/cm2 and 500-2000 msec duration were performed at several planes in the plaque. During therapy, pulsed HIFU was interleaved with single transmit focus imaging from the DMUA and M2D imaging from the diagnostic transducer for further analysis of lesion formation. After therapy, the swine's were recovered and later sacrificed after 4 and 7 days for histological analysis of lesion formation. At sacrifice, the lower half of the swine was perfused and the femoral artery with adjoining muscle was fixed and stained with H&E to characterize HIFU-induced lesions. Histology has confirmed that localized thermal lesion formation within the plaque was achieved according to the planned lesion maps. Furthermore, the damage was confined to the plaque tissue without damage to the intima. These results offer the promise of a new treatment potentially suited for vulnerable plaques. The results also provide the first real-time demonstration of DMUA technology in targeting fine tissue structures for

  15. Predictors of Toxicity After Image-guided High-dose-rate Interstitial Brachytherapy for Gynecologic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Larissa J. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States); Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States)

    2012-12-01

    Purpose: To identify predictors of grade 3-4 complications and grade 2-4 rectal toxicity after three-dimensional image-guided high-dose-rate (HDR) interstitial brachytherapy for gynecologic cancer. Methods and Materials: Records were reviewed for 51 women (22 with primary disease and 29 with recurrence) treated with HDR interstitial brachytherapy. A single interstitial insertion was performed with image guidance by computed tomography (n = 43) or magnetic resonance imaging (n = 8). The median delivered dose in equivalent 2-Gy fractions was 72.0 Gy (45 Gy for external-beam radiation therapy and 24 Gy for brachytherapy). Toxicity was reported according to the Common Toxicity Criteria for Adverse Events. Actuarial toxicity estimates were calculated by the Kaplan-Meier method. Results: At diagnosis, the median patient age was 62 years and the median tumor size was 3.8 cm. The median D90 and V100 were 71.4 Gy and 89.5%; the median D2cc for the bladder, rectum, and sigmoid were 64.6 Gy, 61.0 Gy, and 52.7 Gy, respectively. The actuarial rates of all grade 3-4 complications at 2 years were 20% gastrointestinal, 9% vaginal, 6% skin, 3% musculoskeletal, and 2% lymphatic. There were no grade 3-4 genitourinary complications and no grade 5 toxicities. Grade 2-4 rectal toxicity was observed in 10 patients, and grade 3-4 complications in 4; all cases were proctitis with the exception of 1 rectal fistula. D2cc for rectum was higher for patients with grade 2-4 (68 Gy vs 57 Gy for grade 0-1, P=.03) and grade 3-4 (73 Gy vs 58 Gy for grade 0-2, P=.02) rectal toxicity. The estimated dose that resulted in a 10% risk of grade 2-4 rectal toxicity was 61.8 Gy (95% confidence interval, 51.5-72.2 Gy). Discussion: Image-guided HDR interstitial brachytherapy results in acceptable toxicity for women with primary or recurrent gynecologic cancer. D2cc for the rectum is a reliable predictor of late rectal complications. Three-dimensional-based treatment planning should be performed to ensure

  16. Transition from Paris dosimetry system to 3D image-guided planning in interstitial breast brachytherapy.

    Science.gov (United States)

    Wiercińska, Judyta; Wronczewska, Anna; Kabacińska, Renata; Makarewicz, Roman

    2015-12-01

    The purpose of this study is to evaluate our first experience with 3D image-guided breast brachytherapy and to compare dose distribution parameters between Paris dosimetry system (PDS) and image-based plans. First 49 breast cancer patients treated with 3D high-dose-rate interstitial brachytherapy as a boost were selected for the study. Every patient underwent computed tomography, and the planning target volume (PTV) and organs at risk (OAR) were outlined. Two treatment plans were created for every patient. First, based on a Paris dosimetry system (PDS), and the second one, imaged-based plan with graphical optimization (OPT). The reference isodose in PDS implants was 85%, whereas in OPT plans the isodose was chosen to obtain proper target coverage. Dose and volume parameters (D90, D100, V90, V100), doses at OARs, total reference air kerma (TRAK), and quality assurance parameters: dose nonuniformity ratio (DNR), dose homogeneity index (DHI), and conformity index (COIN) were used for a comparison of both plans. The mean number of catheters was 7 but the mean for 20 first patients was 5 and almost 9 for the next 29 patients. The mean value of prescribed isodose for OPT plans was 73%. The mean D90 was 88.2% and 105.8%, the D100 was 59.8% and 75.7%, the VPTV90 was 88.6% and 98.1%, the VPTV100 was 79.9% and 98.9%, and the TRAK was 0.00375 Gym(-1) and 0.00439 Gym(-1) for the PDS and OPT plans, respectively. The mean DNR was 0.29 and 0.42, the DHI was 0.71 and 0.58, and the COIN was 0.68 and 0.76, respectively. The target coverage in image-guided plans (OPT) was significantly higher than in PDS plans but the dose homogeneity was worse. Also, the value of TRAK increased because of change of prescribing isodose. The learning curve slightly affected our results.

  17. SU-E-J-123: Targeting Accuracy of Image-Guided Radiosurgery for Intracranial Lesions

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Y; Wen, N; Zhao, B; Kim, J; Gordon, J; Chetty, I [Henry Ford Health System, Detroit, MI (United States)

    2014-06-01

    Purpose: To evaluate the setup accuracies of image-guided intracranial radiosurgery across several different linear accelerator platforms. Methods: A CT scan with a slice thickness of 1.0 mm was acquired of a Rando head phantom (The Phantom Laboratory) in a U-frame mask (BrainLAB AG). The phantom had three embedded BBs, simulating a central, left, and anterior lesion. The phantom was setup with each BB placed at the radiation isocenter under image guidance. Four different setup procedures were investigated: (1) NTX-ExacTrac: 6 degree-of-freedom (6D) correction on a Novalis Tx (BrainLAB AG) with ExacTrac localization (BrainLAB AG); (2) NTX-CBCT: 4D correction on the Novalis Tx with cone-beam computed tomography (CBCT); (3) TrueBeam-CBCT: 4D correction on a TrueBeam (Varian) with CBCT; (4) Edge-CBCT: 6D correction on an Edge (Varian) with CBCT. The experiment was repeated 5 times with different initial setup error at each BB location on each platform, and the mean (μ) and one standard deviation (σ) of the residual error was compared.The congruence between radiation and imaging isocenters on each platform was evaluated by acquiring Winston Lutz (WL) images of a WL jig followed by imaging using ExacTrac or CBCT. The difference in coordinates of the jig relative to radiation and imaging isocenters was then recorded. Results: Averaged over all three BB locations, the residual vector setup errors (μ±σ) of the phantom in mm were 0.6±0.2, 1.0±0.5, 0.2±0.1, and 0.3±0.1 on NTX-ExacTrac, NTX-CBCT, TrueBeam-CBCT, and Edge-CBCT, with their ranges in mm being 0.4∼1.1, 0.4∼1.9, 0.1∼0.5, and 0.2∼0.6, respectively. And imaging isocenter was found stable relative to radiation isocenter, with the congruence to radiation isocenter in mm being 0.6±0.1, 0.7±0.1, 0.3±0.1, 0.2±0.1, respectively, on the four systems in the same order. Conclusion: Millimeter accuracy can be achieved with image-guided radiosurgery for intracranial lesions based on this set of experiments.

  18. Robotic surgery.

    Science.gov (United States)

    Diana, M; Marescaux, J

    2015-01-01

    Proficiency in minimally invasive surgery requires intensive and continuous training, as it is technically challenging for unnatural visual and haptic perceptions. Robotic and computer sciences are producing innovations to augment the surgeon's skills to achieve accuracy and high precision during complex surgery. This article reviews the current use of robotically assisted surgery, focusing on technology as well as main applications in digestive surgery, and future perspectives. The PubMed database was interrogated to retrieve evidence-based data on surgical applications. Internal and external consulting with key opinion leaders, renowned robotics laboratories and robotic platform manufacturers was used to produce state-of-the art business intelligence around robotically assisted surgery. Selected digestive procedures (oesophagectomy, gastric bypass, pancreatic and liver resections, rectal resection for cancer) might benefit from robotic assistance, although the current level of evidence is insufficient to support widespread adoption. The surgical robotic market is growing, and a variety of projects have recently been launched at both academic and corporate levels to develop lightweight, miniaturized surgical robotic prototypes. The magnified view, and improved ergonomics and dexterity offered by robotic platforms, might facilitate the uptake of minimally invasive procedures. Image guidance to complement robotically assisted procedures, through the concepts of augmented reality, could well represent a major revolution to increase safety and deal with difficulties associated with the new minimally invasive approaches. © 2015 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  19. Robotic buildings(s)

    NARCIS (Netherlands)

    Bier, H.H.

    2014-01-01

    Technological and conceptual advances in fields such as artificial intelligence, robotics, and material science have enabled robotic building to be in the last decade prototypically implemented. In this context, robotic building implies both physically built robotic environments and robotically supp

  20. Robotic buildings(s)

    NARCIS (Netherlands)

    Bier, H.H.

    2014-01-01

    Technological and conceptual advances in fields such as artificial intelligence, robotics, and material science have enabled robotic building to be in the last decade prototypically implemented. In this context, robotic building implies both physically built robotic environments and robotically supp

  1. Evaluation of 3 different registration techniques in image-guided bimaxillary surgery.

    Science.gov (United States)

    Sun, Yi; Luebbers, Heinz-Theo; Agbaje, Jimoh Olubanwo; Schepers, Serge; Vrielinck, Luc; Lambrichts, Ivo; Politis, Constantinus

    2013-07-01

    Perioperative navigation is an upcoming tool in orthognathic surgery. This study aimed to access the feasibility of the technique and to evaluate the success rate of 3 different registration methods--facial surface registration, anatomic landmark-based registration, and template-based registration. The BrainLab navigation system (BrainLab AG, Feldkirchen, Germany) was used as an additional precision tool for 85 patients who underwent bimaxillary orthognathic surgery from February 2010 to June 2012. Eighteen cases of facial surface-based registration, 63 cases of anatomic landmark-based registration, and 8 cases of template-based registration were analyzed. The overall success rate of facial surface-based registration was 39%, which was significant lower than template-based (100%, P = 0.013) and anatomic landmark-based registration (95%, P bimaxillary orthognathic surgery has been proved to be feasible. The registration process is the critical point regarding success of intraoperative navigation. Anatomic landmark-based registration is a reliable technique for image-guided bimaxillary surgery. In contrast, facial surface-based registration is highly unreliable.

  2. The accuracy of image-guided navigation for maxillary positioning in bimaxillary surgery.

    Science.gov (United States)

    Sun, Yi; Luebbers, Heinz-Theo; Agbaje, Jimoh Olubanwo; Lambrichts, Ivo; Politis, Constantinus

    2014-05-01

    The aim of our study was to evaluate the accuracy of image-guided maxillary positioning in sagittal, vertical, and mediolateral direction. Between May 2011 and July 2012, 17 patients (11 males, 6 females) underwent bimaxillary surgery with the use of intraoperative surgical navigation. During Le Fort I osteotomy, the Kolibri navigation system was used to measure movement of the maxilla at the edge of the upper central upper incisor in sagittal (buccal surface), vertical (incisor edge), and mediolateral (dental midline) direction. Six weeks after surgery, a postoperative CBCT scan was taken and registered to the preoperative cone-beam computed tomography scan to identify the actual surgical movement of the maxilla. Student 2-tailed paired t test was used to evaluate differences between the measured result from navigation system and actual surgical movement of the maxilla, which were 0.44 ± 0.35 mm (P = 0.82) in the sagittal, 0.50 ± 0.35 mm (P = 0.85) in the vertical, and 0.56 ± 0.36 mm (P = 0.81) in the mediolateral direction. Our finding demonstrates that intraoperative computer navigation is a promising tool for measuring the surgical change of the maxilla in bimaxillary surgery.

  3. Microenvironment-Driven Bioelimination of Magnetoplasmonic Nanoassemblies and Their Multimodal Imaging-Guided Tumor Photothermal Therapy.

    Science.gov (United States)

    Li, Linlin; Fu, Shiyan; Chen, Chuanfang; Wang, Xuandong; Fu, Changhui; Wang, Shu; Guo, Weibo; Yu, Xin; Zhang, Xiaodi; Liu, Zhirong; Qiu, Jichuan; Liu, Hong

    2016-07-26

    Biocompatibility and bioelimination are basic requirements for systematically administered nanomaterials for biomedical purposes. Gold-based plasmonic nanomaterials have shown potential applications in photothermal cancer therapy. However, their inability to biodegrade has impeded practical biomedical application. In this study, a kind of bioeliminable magnetoplasmonic nanoassembly (MPNA), assembled from an Fe3O4 nanocluster and gold nanoshell, was elaborately designed for computed tomography, photoacoustic tomography, and magnetic resonance trimodal imaging-guided tumor photothermal therapy. A single dose of photothermal therapy under near-infrared light induced a complete tumor regression in mice. Importantly, MPNAs could respond to the local microenvironment with acidic pH and enzymes where they accumulated including tumors, liver, spleen, etc., collapse into small molecules and discrete nanoparticles, and finally be cleared from the body. With the bioelimination ability from the body, a high dose of 400 mg kg(-1) MPNAs had good biocompatibility. The MPNAs for cancer theranostics pave a way toward biodegradable bio-nanomaterials for biomedical applications.

  4. Knowledge modeling in image-guided neurosurgery: application in understanding intraoperative brain shift

    Science.gov (United States)

    Cohen-Adad, Julien; Paul, Perrine; Morandi, Xavier; Jannin, Pierre

    2006-03-01

    During an image-guided neurosurgery procedure, the neuronavigation system is subject to inaccuracy because of anatomical deformations which induce a gap between the preoperative images and their anatomical reality. Thus, the objective of many research teams is to succeed in quantifying these deformations in order to update preoperative images. Anatomical intraoperative deformations correspond to a complex spatio-temporal phenomenon. Our objective is to identify the parameters implicated in these deformations and to use these parameters as constrains for systems dedicated to updating preoperative images. In order to identify these parameters of deformation we followed the iterative methodology used for cognitive system conception: identification, conceptualization, formalization, implementation and validation. A state of the art about cortical deformations has been established in order to identify relevant parameters probably involved in the deformations. As a first step, 30 parameters have been identified and described following an ontological approach. They were formalized into a Unified Modeling Language (UML) class diagram. We implemented that model into a web-based application in order to fill a database. Two surgical cases have been studied at this moment. After having entered enough surgical cases for data mining purposes, we expect to identify the most relevant and influential parameters and to gain a better ability to understand the deformation phenomenon. This original approach is part of a global system aiming at quantifying and correcting anatomical deformations.

  5. Development and application of stent-based image guided navigation system for oral and maxillofacial surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Woo Jin; Kim, Dae Seung [Interdisciplinary Program in Radiation Applied Life Science, Dental Research Institute and BK21, College of Medicine, Seoul National University, Seoul (Korea, Republic of); Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul; Heo, Min Suk; Huh, Kyung Hoe; Kim, Myung Jin; Lee, Jee Ho [Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2009-09-15

    The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. We devised a patient-specific stent for patient-to-image registration and navigation. Three dimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. The accuracy over 8 anatomical landmarks showed an overall mean of 0.56 {+-} 0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.

  6. A small animal image guided irradiation system study using 3D dosimeters

    Science.gov (United States)

    Qian, Xin; Admovics, John; Wuu, Cheng-Shie

    2015-01-01

    In a high resolution image-guided small animal irradiation platform, a cone beam computed tomography (CBCT) is integrated with an irradiation unit for precise targeting. Precise quality assurance is essential for both imaging and irradiation components. The conventional commissioning techniques with films face major challenges due to alignment uncertainty and labour intensive film preparation and scanning. In addition, due to the novel design of this platform the mouse stage rotation for CBCT imaging is perpendicular to the gantry rotation for irradiation. Because these two rotations are associated with different mechanical systems, discrepancy between rotation isocenters exists. In order to deliver x-ray precisely, it is essential to verify coincidence of the imaging and the irradiation isocenters. A 3D PRESAGE dosimeter can provide an excellent tool for checking dosimetry and verifying coincidence of irradiation and imaging coordinates in one system. Dosimetric measurements were performed to obtain beam profiles and percent depth dose (PDD). Isocentricity and coincidence of the mouse stage and gantry rotations were evaluated with starshots acquired using PRESAGE dosimeters. A single PRESAGE dosimeter can provide 3 -D information in both geometric and dosimetric uncertainty, which is crucial for translational studies.

  7. Evaluation of visualization techniques for image-guided navigation in liver surgery.

    Science.gov (United States)

    Vetter, Marcus; Hassenpflug, Peter; Thorn, Matthias; Cárdenas, Carlos; Richter, Götz Martin; Lamadé, Wolfram; Herfarth, Christian; Meinzer, Hans-Peter

    2002-01-01

    A substantial component of an image-guided surgery system (IGSS) is the kind of three-dimensional (3D) presentation to the surgeon because the visual depth perception of the complex anatomy is of significant relevance for orientation. Therefore, we examined in this contribution four different visualization techniques, which were evaluated by eight surgeons. The IGSS developed by our group supports the intraoperative orientation of the surgeon by depicting a visualization of the spatially tracked surgical instruments with respect to intrahepatic vessels that have to be conserved vitally, the tumor, and preoperatively calculated resection planes. In the prelimenary trial presented here we examined the human ability to percept an intraoperative virtual scene and to solve given navigation tasks. The focus of the experiments was to measure the ability of eight surgeons to orientate intrahepaticaly and to transfer the percepted spatial relation to movements in real space. An autostereoscopic visualization with a prism-based display yielded that the navigation can be performed faster and more accurately than with the other visualization techniques.

  8. Imaging-guided two-photon excitation-emission-matrix measurements of human skin tissues

    Science.gov (United States)

    Yu, Yingqiu; Lee, Anthony M. D.; Wang, Hequn; Tang, Shuo; Zhao, Jianhua; Lui, Harvey; Zeng, Haishan

    2012-07-01

    There are increased interests on using multiphoton imaging and spectroscopy for skin tissue characterization and diagnosis. However, most studies have been done with just a few excitation wavelengths. Our objective is to perform a systematic study of the two-photon fluorescence (TPF) properties of skin fluorophores, normal skin, and diseased skin tissues. A nonlinear excitation-emission-matrix (EEM) spectroscopy system with multiphoton imaging guidance was constructed. A tunable femtosecond laser was used to vary excitation wavelengths from 730 to 920 nm for EEM data acquisition. EEM measurements were performed on excised fresh normal skin tissues, seborrheic keratosis tissue samples, and skin fluorophores including: NADH, FAD, keratin, melanin, collagen, and elastin. We found that in the stratum corneum and upper epidermis of normal skin, the cells have large sizes and the TPF originates from keratin. In the lower epidermis, cells are smaller and TPF is dominated by NADH contributions. In the dermis, TPF is dominated by elastin components. The depth resolved EEM measurements also demonstrated that keratin structure has intruded into the middle sublayers of the epidermal part of the seborrheic keratosis lesion. These results suggest that the imaging guided TPF EEM spectroscopy provides useful information for the development of multiphoton clinical devices for skin disease diagnosis.

  9. Intelligent multisensor concept for image-guided 3D object measurement with scanning laser radar

    Science.gov (United States)

    Weber, Juergen

    1995-08-01

    This paper presents an intelligent multisensor concept for measuring 3D objects using an image guided laser radar scanner. The field of application are all kinds of industrial inspection and surveillance tasks where it is necessary to detect, measure and recognize 3D objects in distances up to 10 m with high flexibility. Such applications might be the surveillance of security areas or container storages as well as navigation and collision avoidance of autonomous guided vehicles. The multisensor system consists of a standard CCD matrix camera and a 1D laser radar ranger which is mounted to a 2D mirror scanner. With this sensor combination it is possible to acquire gray scale intensity data as well as absolute 3D information. To improve the system performance and flexibility, the intensity data of the scene captured by the camera can be used to focus the measurement of the 3D sensor to relevant areas. The camera guidance of the laser scanner is useful because the acquisition of spatial information is relatively slow compared to the image sensor's ability to snap an image frame in 40 ms. Relevant areas in a scene are located by detecting edges of objects utilizing various image processing algorithms. The complete sensor system is controlled by three microprocessors carrying out the 3D data acquisition, the image processing tasks and the multisensor integration. The paper deals with the details of the multisensor concept. It describes the process of sensor guidance and 3D measurement and presents some practical results of our research.

  10. Near-infrared image-guided laser ablation of dental decay

    Science.gov (United States)

    Tao, You-Chen; Fried, Daniel

    2009-09-01

    Image-guided laser ablation systems are now feasible for dentistry with the recent development of nondestructive high-contrast imaging modalities such as near-IR (NIR) imaging and optical coherence tomography (OCT) that are capable of discriminating between sound and demineralized dental enamel at the early stages of development. Our objective is to demonstrate that images of demineralized tooth surfaces have sufficient contrast to be used to guide a CO2 laser for the selective removal of natural and artificial caries lesions. NIR imaging and polarization-sensitive optical coherence tomography (PS-OCT) operating at 1310-nm are used to acquire images of natural lesions on extracted human teeth and highly patterned artificial lesions produced on bovine enamel. NIR and PS-OCT images are analyzed and converted to binary maps designating the areas on the samples to be removed by a CO2 laser to selectively remove the lesions. Postablation NIR and PS-OCT images confirmed preferential removal of demineralized areas with minimal damage to sound enamel areas. These promising results suggest that NIR and PS-OCT imaging systems can be integrated with a CO2 laser ablation system for the selective removal of dental caries.

  11. Wall suction-assisted image-guided thoracentesis: a safe alternative to evacuated bottles.

    Science.gov (United States)

    Kim, H; Shyn, P B; Wu, L; Levesque, V M; Khorasani, R; Silverman, S G

    2017-10-01

    To compare the safety of evacuated bottle-assisted thoracentesis with wall suction-assisted thoracentesis. An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study of 161 consecutive patients who underwent 191 evacuated bottle-assisted thoracenteses from 1 January 2012 to 30 September 2012, and 188 consecutive patients who underwent 230 wall suction-assisted thoracenteses from 1 January 2013 to 30 September 2013 was conducted. All procedures used imaging guidance. Primary diagnosis, age, gender, total fluid volume removed, and adverse events (AE) up to 30 days post-procedure were recorded and graded using Common Terminology Criteria for Adverse Events 4.0 (CTCAE)(2). Overall AE rates were 42.9% (82/191) for the evacuated bottle group and 19.6% (45/230) for the wall suction group (psuction group, [41.9% (80/191) and 18.3% (42/230)], respectively (psuction groups, respectively. No grade 4 or 5 AE occurred. Excluding transient chest pain and cough, there was no statistical difference in overall AE rate between the evacuated bottle and wall suction groups [11% (21/191) and 8.3% (19/230), p=0.4]. Image-guided thoracentesis performed with wall suction is safe when compared to evacuated bottles. The use of wall suction, in comparison to evacuated bottles, may decrease the incidence of transient chest pain or cough. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. 5-ALA Fluorescence Image Guided Resection of Glioblastoma Multiforme: A Meta-Analysis of the Literature

    Directory of Open Access Journals (Sweden)

    Samy Eljamel

    2015-05-01

    Full Text Available Background: Glioblastoma multiforme (GBM is one of the most deadly cancers in humans. Despite recent advances in anti-cancer therapies, most patients with GBM die from local disease progression. Fluorescence image guided surgical resection (FIGR was recently advocated to enhance local control of GBM. This is meta-analyses of 5-aminolevulinic (5-ALA induced FIGR. Materials: Review of the literature produced 503 potential publications; only 20 of these fulfilled the inclusion criteria of this analysis, including a total of 565 patients treated with 5-ALA-FIGR reporting on its outcomes and 800 histological samples reporting 5-ALA-FIGR sensitivity and specificity. Results: The mean gross total resection (GTR rate was 75.4% (95% CI: 67.4–83.5, p < 0.001. The mean time to tumor progression (TTP was 8.1 months (95% CI: 4.7–12, p < 0.001. The mean overall survival gain reported was 6.2 months (95% CI: −1–13, p < 0.001. The specificity was 88.9% (95% CI: 83.9–93.9, p < 0.001 and the sensitivity was 82.6% (95% CI: 73.9–91.9, p < 0.001. Conclusion: 5-ALA-FIGR in GBM is highly sensitive and specific, and imparts significant benefits to patients in terms of improved GTR and TTP.

  13. A microelectronic portal imaging device for image guided conformal microirradiation of murine cancer models.

    Science.gov (United States)

    Price, Samantha G; Silvius, Alexander A; Izaguirre, Enrique W

    2014-01-01

    Image guided conformal small animal orthovoltage microirradiators are currently under development to perform radiobiological experiments with preclinical cancer models. An important component of these instruments is the treatment delivery image guidance system, a microelectronic portal imaging device (μEPID). Here, we present the design and implementation of a μEPID, specifically designed and constructed for small animal orthovoltage microirradiators. The μEPID can acquire images in the range of 60 kVp to 320 kVp x-ray photon energies and can endure high doses from orthovoltage beams without radiation damage. The μEPID can acquire 200 μm resolution images at a rate of 17 frames per second for online in vivo co-registration between irradiation beams and small animal anatomy. An exposure with less than 1% of a 2 Gy treatment field is required for imaging, which is an adequate ratio between imaging dose and treatment dose to avoid undesired irradiation of healthy tissue or alteration of the preclinical cancer model. The μEPID was calibrated for microdosimetry with a precision of 4.1% with respect to an ion chamber, used as a gold standard. To validate the in vivo device performance, irradiations of lung, brain, and xenograft breast cancer preclinical models were performed and analyzed.

  14. Optoacoustic imaging of the prostate: development toward image-guided biopsy.

    Science.gov (United States)

    Yaseen, Mohammad A; Ermilov, Sergey A; Brecht, Hans-Peter; Su, Richard; Conjusteau, André; Fronheiser, Matthew; Bell, Brent A; Motamedi, Massoud; Oraevsky, Alexander A

    2010-01-01

    Optoacoustic (OA) tomography has demonstrated utility in identifying blood-rich malignancies in breast tissue. We describe the development and characterization of a laser OA imaging system for the prostate (LOIS-P). The system consists of a fiber-coupled Q-switched laser operating at 757 nm, a commercial 128-channel ultrasonic probe, a digital signal processor, and software that uses the filtered radial back-projection algorithm for image reconstruction. The system is used to reconstruct OA images of a blood-rich lesion induced in vivo in a canine prostate. OA images obtained in vivo are compared to images acquired using ultrasound, the current gold standard for guiding biopsy of the prostate. Although key structural features such as the urethra could be identified with both imaging techniques, a bloody lesion representing a highly vascularized tumor could only be clearly identified in OA images. The advantages and limitations of both forward and backward illumination modes are also evaluated by collecting OA images of phantoms simulating blood vessels within tissue. System resolution is estimated to be 0.2 mm in the radial direction of the acoustic array. The minimum detectable pressure signal is 1.83 Pa. Our results encourage further development toward a dual-modality OA/ultrasonic system for prostate imaging and image-guided biopsy.

  15. Image-guided multipolar radiofrequency ablation of liver tumours: initial clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Terraz, Sylvain; Constantin, Christophe; Becker, Christoph D. [Geneva University Hospital, Department of Radiology, Geneva 14 (Switzerland); Majno, Pietro Edoardo; Mentha, Gilles [Geneva University Hospital, Department of Surgery, Geneva 14 (Switzerland); Spahr, Laurent [Geneva University Hospital, Department of Gastroenterology, Geneva 14 (Switzerland)

    2007-09-15

    The local effectiveness and clinical usefulness of multipolar radiofrequency (RF) ablation of liver tumours was evaluated. Sixty-eight image-guided RF sessions were performed using a multipolar device with bipolar electrodes in 53 patients. There were 45 hepatocellular carcinomas (HCC) and 42 metastases with a diameter {<=}3 cm (n = 55), 3.1-5 cm (n = 29) and >5 cm (n = 3); 26 nodules were within 5 mm from large vessels. Local effectiveness and complications were evaluated after RF procedures. Mean follow-up was 17 {+-} 10 months. Recurrence and survival rates were analysed by the Kaplan-Meier method. The primary and secondary technical effectiveness rate was 82% and 95%, respectively. The major and minor complication rate was 2.9%, respectively. The local tumour progression at 1- and 2-years was 5% and 9% for HCC nodules and 17% and 31% for metastases, respectively; four of 26 nodules (15%) close to vessels showed local progression. The survival at 1 year and 2 years was 97% and 90% for HCC and 84% and 68% for metastases, respectively. Multipolar RF technique creates ablation zones of adequate size and tailored shape and is effective to treat most liver tumours, including those close to major hepatic vessels. (orig.)

  16. CustusX: an open-source research platform for image-guided therapy.

    Science.gov (United States)

    Askeland, Christian; Solberg, Ole Vegard; Bakeng, Janne Beate Lervik; Reinertsen, Ingerid; Tangen, Geir Arne; Hofstad, Erlend Fagertun; Iversen, Daniel Høyer; Våpenstad, Cecilie; Selbekk, Tormod; Langø, Thomas; Hernes, Toril A Nagelhus; Olav Leira, Håkon; Unsgård, Geirmund; Lindseth, Frank

    2016-04-01

    CustusX is an image-guided therapy (IGT) research platform dedicated to intraoperative navigation and ultrasound imaging. In this paper, we present CustusX as a robust, accurate, and extensible platform with full access to data and algorithms and show examples of application in technological and clinical IGT research. CustusX has been developed continuously for more than 15 years based on requirements from clinical and technological researchers within the framework of a well-defined software quality process. The platform was designed as a layered architecture with plugins based on the CTK/OSGi framework, a superbuild that manages dependencies and features supporting the IGT workflow. We describe the use of the system in several different clinical settings and characterize major aspects of the system such as accuracy, frame rate, and latency. The validation experiments show a navigation system accuracy of [Formula: see text]1.1 mm, a frame rate of 20 fps, and latency of 285 ms for a typical setup. The current platform is extensible, user-friendly and has a streamlined architecture and quality process. CustusX has successfully been used for IGT research in neurosurgery, laparoscopic surgery, vascular surgery, and bronchoscopy. CustusX is now a mature research platform for intraoperative navigation and ultrasound imaging and is ready for use by the IGT research community. CustusX is open-source and freely available at http://www.custusx.org.

  17. Superiority of autostereoscopic visualization for image-guided navigation in liver surgery

    Science.gov (United States)

    Vetter, Marcus; Hassenpflug, Peter; Thorn, Matthias; Cardenas, Carlos; Grenacher, Lars; Richter, Goetz M.; Lamade, Wolfram; Herfarth, Christian; Meinzer, Hans-Peter

    2002-05-01

    A substantial component of an image-guided surgery system (IGSS) is the kind of three-dimensional (3D) presentation to the surgeon because the visual depth perception of the complex anatomy is of significant relevance for orientation. Therefore, we examined for this contribution four different visualization techniques, which were evaluated by eight surgeons. The IGSS developed by our group supports the intraoperative orientation of the surgeon by presenting a visualization of the spatially tracked surgical instruments with respect to vitally important intrahepatic vessels, the tumor, and preoperatively calculated resection planes. In the preliminary trial presented here, we examined the human ability to perceive an intraoperative virtual scene and to solve given navigation tasks. The focus of the experiments was to measure the ability of eight surgeons to orientate themselves intrahepatically and to transfer the perceived virtual spatial relations to movements in real space. With auto-stereoscopic visualization making use of a prism-based display the navigation can be performed faster and more accurate than with the other visualization techniques.

  18. A finite state model for respiratory motion analysis in image guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wu Huanmei [College of Computer and Information Science, Northeastern University, Boston, MA 02115 (United States); Sharp, Gregory C [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States); Salzberg, Betty [College of Computer and Information Science, Northeastern University, Boston, MA 02115 (United States); Kaeli, David [Department of Electrical and Computer Engineering, Northeastern University, Boston, MA 02115 (United States); Shirato, Hiroki [Department of Radiation Medicine, Hokkaido University School of Medicine, Sapporo (Japan); Jiang, Steve B [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)

    2004-12-07

    Effective image guided radiation treatment of a moving tumour requires adequate information on respiratory motion characteristics. For margin expansion, beam tracking and respiratory gating, the tumour motion must be quantified for pretreatment planning and monitored on-line. We propose a finite state model for respiratory motion analysis that captures our natural understanding of breathing stages. In this model, a regular breathing cycle is represented by three line segments, exhale, end-of-exhale and inhale, while abnormal breathing is represented by an irregular breathing state. In addition, we describe an on-line implementation of this model in one dimension. We found this model can accurately characterize a wide variety of patient breathing patterns. This model was used to describe the respiratory motion for 23 patients with peak-to-peak motion greater than 7 mm. The average root mean square error over all patients was less than 1 mm and no patient has an error worse than 1.5 mm. Our model provides a convenient tool to quantify respiratory motion characteristics, such as patterns of frequency changes and amplitude changes, and can be applied to internal or external motion, including internal tumour position, abdominal surface, diaphragm, spirometry and other surrogates.

  19. Designing a wearable navigation system for image-guided cancer resection surgery.

    Science.gov (United States)

    Shao, Pengfei; Ding, Houzhu; Wang, Jinkun; Liu, Peng; Ling, Qiang; Chen, Jiayu; Xu, Junbin; Zhang, Shiwu; Xu, Ronald

    2014-11-01

    A wearable surgical navigation system is developed for intraoperative imaging of surgical margin in cancer resection surgery. The system consists of an excitation light source, a monochromatic CCD camera, a host computer, and a wearable headset unit in either of the following two modes: head-mounted display (HMD) and Google glass. In the HMD mode, a CMOS camera is installed on a personal cinema system to capture the surgical scene in real-time and transmit the image to the host computer through a USB port. In the Google glass mode, a wireless connection is established between the glass and the host computer for image acquisition and data transport tasks. A software program is written in Python to call OpenCV functions for image calibration, co-registration, fusion, and display with augmented reality. The imaging performance of the surgical navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex vivo tissue model. Surgical margins identified by the wearable navigation system are co-incident with those acquired by a standard small animal imaging system, indicating the technical feasibility for intraoperative surgical margin detection. The proposed surgical navigation system combines the sensitivity and specificity of a fluorescence imaging system and the mobility of a wearable goggle. It can be potentially used by a surgeon to identify the residual tumor foci and reduce the risk of recurrent diseases without interfering with the regular resection procedure.

  20. Image-guided therapy system for interstitial gynecologic brachytherapy in a multimodality operating suite.

    Science.gov (United States)

    Egger, Jan

    2013-01-01

    In this contribution, an image-guided therapy system supporting gynecologic radiation therapy is introduced. The overall workflow of the presented system starts with the arrival of the patient and ends with follow-up examinations by imaging and a superimposed visualization of the modeled device from a PACS system. Thereby, the system covers all treatments stages (pre-, intra- and postoperative) and has been designed and constructed by a computer scientist with feedback from an interdisciplinary team of physicians and engineers. This integrated medical system enables dispatch of diagnostic images directly after acquisition to a processing workstation that has an on-board 3D Computer Aided Design model of a medical device. Thus, allowing precise identification of catheter location in the 3D imaging model which later provides rapid feedback to the clinician regarding device location. Moreover, the system enables the ability to perform patient-specific pre-implant evaluation by assessing the placement of interstitial needles prior to an intervention via virtual template matching with a diagnostic scan.

  1. Image-Guided Transcranial Focused Ultrasound Stimulates Human Primary Somatosensory Cortex

    Science.gov (United States)

    Lee, Wonhye; Kim, Hyungmin; Jung, Yujin; Song, In-Uk; Chung, Yong An; Yoo, Seung-Schik

    2015-03-01

    Focused ultrasound (FUS) has recently been investigated as a new mode of non-invasive brain stimulation, which offers exquisite spatial resolution and depth control. We report on the elicitation of explicit somatosensory sensations as well as accompanying evoked electroencephalographic (EEG) potentials induced by FUS stimulation of the human somatosensory cortex. As guided by individual-specific neuroimage data, FUS was transcranially delivered to the hand somatosensory cortex among healthy volunteers. The sonication elicited transient tactile sensations on the hand area contralateral to the sonicated hemisphere, with anatomical specificity of up to a finger, while EEG recordings revealed the elicitation of sonication-specific evoked potentials. Retrospective numerical simulation of the acoustic propagation through the skull showed that a threshold of acoustic intensity may exist for successful cortical stimulation. The neurological and neuroradiological assessment before and after the sonication, along with strict safety considerations through the individual-specific estimation of effective acoustic intensity in situ and thermal effects, showed promising initial safety profile; however, equal/more rigorous precautionary procedures are advised for future studies. The transient and localized stimulation of the brain using image-guided transcranial FUS may serve as a novel tool for the non-invasive assessment and modification of region-specific brain function.

  2. 3D endobronchial ultrasound reconstruction and analysis for multimodal image-guided bronchoscopy

    Science.gov (United States)

    Zang, Xiaonan; Bascom, Rebecca; Gilbert, Christopher R.; Toth, Jennifer W.; Higgins, William E.

    2014-03-01

    State-of-the-art image-guided intervention (IGI) systems for lung-cancer management draw upon high-resolution three-dimensional multi-detector computed-tomography (MDCT) images and bronchoscopic video. An MDCT scan provides a high-resolution three-dimensional (3D) image of the chest that is used for preoperative procedure planning, while bronchoscopy gives live intraoperative video of the endobronchial airway tree structure. However, because neither source provides live extraluminal information on suspect nodules or lymph nodes, endobronchial ultrasound (EBUS) is often introduced during a procedure. Unfortunately, existing IGI systems provide no direct synergistic linkage between the MDCT/video data and EBUS data. Hence, EBUS proves difficult to use and can lead to inaccurate interpretations. To address this drawback, we present a prototype of a multimodal IGI system that brings together the various image sources. The system enables 3D reconstruction and visualization of structures depicted in the 2D EBUS video stream. It also provides a set of graphical tools that link the EBUS data directly to the 3D MDCT and bronchoscopic video. Results using phantom and human data indicate that the new system could potentially enable smooth natural incorporation of EBUS into the system-level work flow of bronchoscopy.

  3. Designing a wearable navigation system for image-guided cancer resection surgery

    Science.gov (United States)

    Shao, Pengfei; Ding, Houzhu; Wang, Jinkun; Liu, Peng; Ling, Qiang; Chen, Jiayu; Xu, Junbin; Zhang, Shiwu; Xu, Ronald

    2015-01-01

    A wearable surgical navigation system is developed for intraoperative imaging of surgical margin in cancer resection surgery. The system consists of an excitation light source, a monochromatic CCD camera, a host computer, and a wearable headset unit in either of the following two modes: head-mounted display (HMD) and Google glass. In the HMD mode, a CMOS camera is installed on a personal cinema system to capture the surgical scene in real-time and transmit the image to the host computer through a USB port. In the Google glass mode, a wireless connection is established between the glass and the host computer for image acquisition and data transport tasks. A software program is written in Python to call OpenCV functions for image calibration, co-registration, fusion, and display with augmented reality. The imaging performance of the surgical navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex vivo tissue model. Surgical margins identified by the wearable navigation system are co-incident with those acquired by a standard small animal imaging system, indicating the technical feasibility for intraoperative surgical margin detection. The proposed surgical navigation system combines the sensitivity and specificity of a fluorescence imaging system and the mobility of a wearable goggle. It can be potentially used by a surgeon to identify the residual tumor foci and reduce the risk of recurrent diseases without interfering with the regular resection procedure. PMID:24980159

  4. Possibility of transrectal photoacoustic imaging-guided biopsy for detection of prostate cancer

    Science.gov (United States)

    Ishihara, Miya; Shinchi, Masayuki; Horiguchi, Akio; Shinmoto, Hiroshi; Tsuda, Hitoshi; Irisawa, Kaku; Wada, Takatsugu; Asano, Tomohiko

    2017-03-01

    A transrectral ultrasonography (TRUS) guided prostate biopsy is mandatory for histological diagnosis in patients with an elevated serum prostate-specific antigen (PSA), but its diagnostic accuracy is not satisfactory; therefore, a considerable number of patients are forced to have an unnecessary repeated biopsy. Photoacoustic (PA) imaging has the ability to visualize the distribution of hemoglobin clearly. Thus, there is the potential to acquire different maps of small vessel networks between cancerous and normal tissue. We developed an original TRUS-type PA probe consisting of a microconvex array transducer with an optical illumination system providing coregistered PA and ultrasound images. The purpose of this study is to demonstrate the clinical possibility of a transrectral PA image. The prostate biopsy cores obtained by transrectal systemic biopsies under TRUS guidance were stained with HE staining and anti-CD34 antibodies as a marker of the endothelium of the blood vessel in order to find a pattern in the map of a small vessel network, which allows for imaging-based identification of prostate cancer. We analyzed the association of PA signal patterns, the cancer location by a magnetic resonance imaging (MRI) study, and the pathological diagnosis with CD34 stains as a prospective intervention study. In order to demonstrate the TRUS-merged-with-PA imaging guided targeted biopsy combined with a standard biopsy for capturing the clinically significant tumors, we developed a puncture needle guide attachment for the original TRUS-type PA probe.

  5. Image-guided Interstitial Photodynamic Therapy for Squamous Cell Carcinomas: Preclinical investigation

    Science.gov (United States)

    Sajisevi, Mirabelle; Rigual, Nestor R; Bellnier, David A.; Seshadri, Mukund

    2014-01-01

    Objective Photodynamic therapy (PDT) is a clinically approved minimally invasive treatment for cancer. In this preclinical study, using an imaging-guided approach, we examined the potential utility of PDT in the management of bulky squamous cell carcinomas (SCCs). Methods To mimic bulky oropharyngeal cancers seen in the clinical setting, intramuscular SCCs were established in six-to-eight week old female C3H mice. Animals were injected with the photosensitizer, 2-[hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH; 0.4 μmol/kg, i.v.) and tumors were illuminated 24 hours post injection with 665 nm light. PDT as a single treatment modality was administered by surface illumination or by interstitial placement of fibers (iPDT). Magnetic resonance imaging was used to guide treatment and assess tumor response to PDT along with correlative histopathologic assessment. Results Interstitial HPPH-PDT resulted in a marked change on T2 maps 24 hours post treatment compared to untreated controls or transcutaneous illumination. Corresponding apparent diffusion coefficient maps also showed hyperintense areas in tumors following iPDT suggestive of effective photodynamic cell kill. Histologic sections (H&E) confirmed presence of extensive tumor necrosis following iPDT. Conclusions These results highlight the potential utility of PDT in the treatment of bulky oropharyngeal cancers. The findings of our study also demonstrate the utility of MRI as a non-invasive tool for mapping of early tissue response to PDT. PMID:25750858

  6. Gold Nanocage-Photosensitizer Conjugates for Dual-Modal Image-Guided Enhanced Photodynamic Therapy

    Science.gov (United States)

    Srivatsan, Avinash; Jenkins, Samir V.; Jeon, Mansik; Wu, Zhijin; Kim, Chulhong; Chen, Jingyi; Pandey, Ravindra K.

    2014-01-01

    We have demonstrated that gold nanocage-photosensitizer conjugates can enable dual image-guided delivery of photosensitizer and significantly improve the efficacy of photodynamic therapy in a murine model. The photosensitizer, 3-devinyl-3-(1'-hexyloxyethyl)pyropheophorbide (HPPH), was noncovalently entrapped in the poly(ethylene glycol) monolayer coated on the surface of gold nanocages. The conjugate is stable in saline solutions, while incubation in protein rich solutions leads to gradual unloading of the HPPH, which can be monitored optically by fluorescence and photoacoustic imaging. The slow nature of the release in turn results in an increase in accumulation of the drug within implanted tumors due to the passive delivery of gold nanocages. Furthermore, the conjugate is found to generate more therapeutic singlet oxygen and have a lower IC50 value than the free drug alone. Thus the conjugate shows significant suppression of tumor growth as compared to the free drug in vivo. Short-term study showed neither toxicity nor phenotypical changes in mice at therapeutic dose of the conjugates or even at 100-fold higher than therapeutic dose of gold nanocages. PMID:24465274

  7. Image-Guided Non-Local Dense Matching with Three-Steps Optimization

    Science.gov (United States)

    Huang, Xu; Zhang, Yongjun; Yue, Zhaoxi

    2016-06-01

    This paper introduces a new image-guided non-local dense matching algorithm that focuses on how to solve the following problems: 1) mitigating the influence of vertical parallax to the cost computation in stereo pairs; 2) guaranteeing the performance of dense matching in homogeneous intensity regions with significant disparity changes; 3) limiting the inaccurate cost propagated from depth discontinuity regions; 4) guaranteeing that the path between two pixels in the same region is connected; and 5) defining the cost propagation function between the reliable pixel and the unreliable pixel during disparity interpolation. This paper combines the Census histogram and an improved histogram of oriented gradient (HOG) feature together as the cost metrics, which are then aggregated based on a new iterative non-local matching method and the semi-global matching method. Finally, new rules of cost propagation between the valid pixels and the invalid pixels are defined to improve the disparity interpolation results. The results of our experiments using the benchmarks and the Toronto aerial images from the International Society for Photogrammetry and Remote Sensing (ISPRS) show that the proposed new method can outperform most of the current state-of-the-art stereo dense matching methods.

  8. Image-guided ultrasound phased arrays are a disruptive technology for non-invasive therapy

    Science.gov (United States)

    Hynynen, Kullervo; Jones, Ryan M.

    2016-09-01

    Focused ultrasound offers a non-invasive way of depositing acoustic energy deep into the body, which can be harnessed for a broad spectrum of therapeutic purposes, including tissue ablation, the targeting of therapeutic agents, and stem cell delivery. Phased array transducers enable electronic control over the beam geometry and direction, and can be tailored to provide optimal energy deposition patterns for a given therapeutic application. Their use in combination with modern medical imaging for therapy guidance allows precise targeting, online monitoring, and post-treatment evaluation of the ultrasound-mediated bioeffects. In the past there have been some technical obstacles hindering the construction of large aperture, high-power, densely-populated phased arrays and, as a result, they have not been fully exploited for therapy delivery to date. However, recent research has made the construction of such arrays feasible, and it is expected that their continued development will both greatly improve the safety and efficacy of existing ultrasound therapies as well as enable treatments that are not currently possible with existing technology. This review will summarize the basic principles, current statures, and future potential of image-guided ultrasound phased arrays for therapy.

  9. Feasibility of Tomotherapy-based image-guided radiotherapy for small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Nam Phong Nguyen

    2013-11-01

    Full Text Available Background: To assess the tolerance of patients with small cell lung cancer undergoing chemoradiation with tomotherapy-based image-guided radiotherapy (IGRT.Materials and methods: A retrospective review of the toxicity profile for nine patients with small cell lung cancer of the limited stage who underwent chemoradiation delivered with helical tomotherapy (HT has been conducted.Results: Acute grade 3-4 hematologic and esophagitis toxicities developed in two and three patients respectively. One patient developed a pulmonary embolism during radiotherapy. Seven patients had weight loss ranging from 0 to 30 pounds (median: 4 pounds. Three patients had treatment breaks ranging from 2 to 12 days. At a median follow-up of 11 months (range: 2-24 months, no patients developed any radiation related toxicities such as grade 3-4 pneumonitis or other long-term complications. The median survival was estimated to be 15 months. There were 2 local recurrences, 3 mediastinal recurrences, and six distant metastases.Conclusion: Grade 3-4 toxicities remained significant during chemoradiation when radiation was delivered with tomotherapy-based IGRT. However, the absence of grade 3-4 pneumonitis is promising and the use of HT needs to be investigated in future prospective studies.

  10. Augmented reality with Microsoft HoloLens holograms for near infrared fluorescence based image guided surgery

    Science.gov (United States)

    Cui, Nan; Kharel, Pradosh; Gruev, Viktor

    2017-02-01

    Near infrared fluorescence (NIRF) based image guided surgery aims to provide vital information to the surgeon in the operating room, such as locations of cancerous tissue that should be resected and healthy tissue that should to be preserved. Targeted molecular markers, such as tumor or nerve specific probes, are used in conjunctions with NIRF imaging and display systems to provide key information to the operator in real-time. One of the major hurdles for the wide adaptation of these imaging systems is the high cost to operate the instruments, large footprint and complexity of operating the systems. The emergence of wearable NIRF systems has addressed these shortcomings by minimizing the imaging and display systems' footprint and reducing the operational cost. However, one of the major shortcomings for this technology is the replacement of the surgeon's natural vision with an augmented reality view of the operating room. In this paper, we have addressed this major shortcoming by exploiting hologram technology from Microsoft HoloLens to present NIR information on a color image captured by the surgeon's natural vision. NIR information is captured with a CMOS sensor with high quantum efficiency in the 800 nm wavelength together with a laser light illumination light source. The NIR image is converted to a hologram that is displayed on Microsoft HoloLens and is correctly co-registered with the operator's natural eyesight.

  11. Image guided, adaptive, accelerated, high dose brachytherapy as model for advanced small volume radiotherapy.

    Science.gov (United States)

    Haie-Meder, Christine; Siebert, Frank-André; Pötter, Richard

    2011-09-01

    Brachytherapy has consistently provided a very conformal radiation therapy modality. Over the last two decades this has been associated with significant improvements in imaging for brachytherapy applications (prostate, gynecology), resulting in many positive advances in treatment planning, application techniques and clinical outcome. This is emphasized by the increased use of brachytherapy in Europe with gynecology as continuous basis and prostate and breast as more recently growing fields. Image guidance enables exact knowledge of the applicator together with improved visualization of tumor and target volumes as well as of organs at risk providing the basis for very individualized 3D and 4D treatment planning. In this commentary the most important recent developments in prostate, gynecological and breast brachytherapy are reviewed, with a focus on European recent and current research aiming at the definition of areas for important future research. Moreover the positive impact of GEC-ESTRO recommendations and the highlights of brachytherapy physics are discussed what altogether presents a full overview of modern image guided brachytherapy. An overview is finally provided on past and current international brachytherapy publications focusing on "Radiotherapy and Oncology". These data show tremendous increase in almost all research areas over the last three decades strongly influenced recently by translational research in regard to imaging and technology. In order to provide high level clinical evidence for future brachytherapy practice the strong need for comprehensive prospective clinical research addressing brachytherapy issues is high-lighted. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. Multifunctional gold nanorods for image-guided surgery and photothermal therapy

    Science.gov (United States)

    Barriere, Clement; Qi, Ji; Garcia-Allende, P. Beatriz; Newton, Richard; Elson, Daniel S.

    2012-03-01

    Nanoparticles are viewed as a promising tool for numerous medical applications, for instance imaging and photothermal therapy (PTT) has been proposed using gold nanorods. We are developing multi-functional gold nanorods (m-GNRs) which have potential for image guided endoscopic surgery of tumour tissue with a modified laparoscope system. A new synthesis method potentially allows any useful acid functionalised molecules to be bonded at the surface. We have created fluorescent m-GNRs which can be used for therapy as they absorb light in the infrared, which may penetrate deep into the tissue and produce localised heating. We have performed a tissue based experiment to demonstrate the feasibility of fluorescence guided PTT using m- GNRs. Ex vivo tests were performed using sheep heart. This measurement, correlated with the fluorescence signal of the m-GNRs measured by the laparoscope allows the clear discrimination of the artery system containing m-GNRs. A laser diode was used to heat the m-GNRs and a thermal camera was able to record the heat distribution. These images were compared to the fluorescence images for validation.

  13. Residual translational and rotational errors after kV X-ray image-guided correction of prostate location using implanted fiducials

    Energy Technology Data Exchange (ETDEWEB)

    Wust, Peter [Dept. of Radiation Oncology, Charite - Univ. Medicine Berlin, Campus Virchow-Klinikum, Berlin (Germany); Graf, Reinhold; Boehmer, Dirk; Budach, Volker

    2010-10-15

    Purpose: To evaluate the residual errors and required safety margins after stereoscopic kilovoltage (kV) X-ray target localization of the prostate in image-guided radiotherapy (IGRT) using internal fiducials. Patients and Methods: Radiopaque fiducial markers (FMs) have been inserted into the prostate in a cohort of 33 patients. The ExacTrac/Novalis Body trademark X-ray 6d image acquisition system (BrainLAB AG, Feldkirchen, Germany) was used. Corrections were performed in left-right (LR), anterior-posterior (AP), and superior-inferior (SI) direction. Rotational errors around LR (x-axis), AP (y) and SI (z) have been recorded for the first series of nine patients, and since 2007 for the subsequent 24 patients in addition corrected in each fraction by using the Robotic Tilt Module trademark and Varian Exact Couch trademark. After positioning, a second set of X-ray images was acquired for verification purposes. Residual errors were registered and again corrected. Results: Standard deviations (SD) of residual translational random errors in LR, AP, and SI coordinates were 1.3, 1.7, and 2.2 mm. Residual random rotation errors were found for lateral (around x, tilt), vertical (around y, table), and longitudinal (around z, roll) and of 3.2 , 1.8 , and 1.5 . Planning target volume (PTV)-clinical target volume (CTV) margins were calculated in LR, AP, and SI direction to 2.3, 3.0, and 3.7 mm. After a second repositioning, the margins could be reduced to 1.8, 2.1, and 1.8 mm. Conclusion: On the basis of the residual setup error measurements, the margin required after one to two online X-ray corrections for the patients enrolled in this study would be at minimum 2 mm. The contribution of intrafractional motion to residual random errors has to be evaluated. (orig.)

  14. Robot umanoidi o robot umani?

    Directory of Open Access Journals (Sweden)

    Domenico Parisi

    2009-01-01

    Full Text Available Che cosa e' un robot? A che cosa serve un robot? Un robot e' qualcosa di fisico, costruito da noi, che somiglia a un organismo vivente e si comporta come un organismo vivente. Gli organismi viventi comprendono gli animali e le piante, ma i robot riproducono gli animali piuttosto che le piante, anche se ci sono tentativi di costruire robotpiante. Comportarsi come un animale significa avere degli organi sensoriali con cui ricevere informazioni dall'ambiente e degli organi motori che permettono di spostarsi nell'ambiente o di muovere una qualche parte del proprio corpo, ad esempio la testa o un braccio, in maniera non programmata, ma autonoma, cioe' rispondendo agli stimoli che arrivano momento per momento ai sensori del robot. Questo risponde alla domanda "Che cosa e' un robot?".

  15. Image-guided intracranial cannula placement for awake in vivo microdialysis in nonhuman primates

    Science.gov (United States)

    Chen, Antong; Bone, Ashleigh; Hines, Catherine D. G.; Dogdas, Belma; Montgomery, Tamara O.; Michener, Maria; Winkelmann, Christopher T.; Ghafurian, Soheil; Lubbers, Laura S.; Renger, John; Bagchi, Ansuman; Uslaner, Jason M.; Johnson, Colena; Zariwala, Hatim A.

    2016-03-01

    Intracranial microdialysis is used for sampling neurochemicals and large peptides along with their metabolites from the interstitial fluid (ISF) of the brain. The ability to perform this in nonhuman primates (NHP) e.g., rhesus could improve the prediction of pharmacokinetic (PK) and pharmacodynamics (PD) action of drugs in human. However, microdialysis in rhesus brains is not as routinely performed as in rodents. One challenge is that the precise intracranial probe placement in NHP brains is difficult due to the richness of the anatomical structure and the variability of the size and shape of brains across animals. Also, a repeatable and reproducible ISF sampling from the same animal is highly desirable when combined with cognitive behaviors or other longitudinal study end points. Toward that end, we have developed a semi-automatic flexible neurosurgical method employing MR and CT imaging to (a) derive coordinates for permanent guide cannula placement in mid-brain structures and (b) fabricate a customized recording chamber to implant above the skull for enclosing and safeguarding access to the cannula for repeated experiments. In order to place the intracranial guide cannula in each subject, the entry points in the skull and the depth in the brain were derived using co-registered images acquired from MR and CT scans. The anterior/posterior (A/P) and medial-lateral (M/L) rotation in the pose of the animal was corrected in the 3D image to appropriately represent the pose used in the stereotactic frame. An array of implanted fiducial markers was used to transform stereotactic coordinates to the images. The recording chamber was custom fabricated using computer-aided design (CAD), such that it would fit the contours of the individual skull with minimum error. The chamber also helped in guiding the cannula through the entry points down a trajectory into the depth of the brain. We have validated our method in four animals and our results indicate average placement error

  16. Magnetic resonance image-guided versus ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Pei-Hong Wu

    2013-01-01

    Image-guided high-intensity focused ultrasound (HIFU) has been used for more than ten years,primarily in the treatment of liver and prostate cancers.HIFU has the advantages of precise cancer ablation and excellent protection of healthy tissue.Breast cancer is a common cancer in women.HIFU therapy,in combination with other therapies,has the potential to improve both oncologic and cosmetic outcomes for breast cancer patients by providing a curative therapy that conserves mammary shape.Currently,HIFU therapy is not commonly used in breast cancer treatment,and efforts to promote the application of HIFU is expected.In this article,we compare different image-guided models for HIFU and reviewed the status,drawbacks,and potential of HIFU therapy for breast cancer.

  17. Accuracy analysis of an image-guided system for vertebroplasty spinal therapy based on electromagnetic tracking of instruments

    Science.gov (United States)

    Ding, Jienan; Khan, Noureen; Cheng, Patrick; Wilson, Emmanuel; Watson, Vance; Cleary, Kevin; Yaniv, Ziv

    2008-03-01

    Vertebroplasty is a minimally invasive procedure in which bone cement is pumped into a fractured vertebral body that has been weakened by osteoporosis, long-term steroid use, or cancer. In this therapy, a trocar (large bore hollow needle) is inserted through the pedicle of the vertebral body which is a narrow passage and requires great skill on the part of the physician to avoid going outside of the pathway. In clinical practice, this procedure is typically done using 2D X-ray fluoroscopy. To investigate the feasibility of providing 3D image guidance, we developed an image-guided system based on electromagnetic tracking and our open source software platform the Image-Guided Surgery Toolkit (IGSTK). The system includes path planning, interactive 3D navigation, and dynamic referencing. This paper will describe the system and our initial evaluation.

  18. A fully automatic image-to-world registration method for image-guided procedure with intraoperative imaging updates

    Science.gov (United States)

    Li, Senhu; Sarment, David

    2016-03-01

    Image-guided procedure with intraoperative imaging updates has made a big impact on minimally invasive surgery. Compact and mobile CT imaging device combining with current commercial available image guided navigation system is a legitimate and cost-efficient solution for a typical operating room setup. However, the process of manual fiducial-based registration between image and physical spaces (image-to-world) is troublesome for surgeons during the procedure, which results in much procedure interruptions and is the main source of registration errors. In this study, we developed a novel method to eliminate the manual registration process. Instead of using probe to manually localize the fiducials during the surgery, a tracking plate with known fiducial positions relative to the reference coordinates is designed and fabricated through 3D printing technique. The workflow and feasibility of this method has been studied through a phantom experiment.

  19. The role of MRI in image-guided needle biopsy of focal bone and soft tissue neoplasms.

    Science.gov (United States)

    Khoo, M M Y; Saifuddin, A

    2013-07-01

    Magnetic resonance imaging (MRI) plays a critical role in the management pathway of both soft tissue and bone neoplasms, from diagnosis through to post-treatment follow-up. There are a wide range of surgical, oncological, and combined treatment regimes but these rely on accurate histopathological diagnosis. This article reviews the role of MRI in the planning of image-guided needle biopsy for suspected soft tissue and bone tumors.

  20. Theoretical aspects of implementation of kilovoltage cone-beam CT onboard linear accelerator for image-guided radiotherapy.

    Science.gov (United States)

    Rodríguez Cordón, Marta; Ferrer Albiach, Carlos

    2009-08-01

    The main objective of image-guided radiation therapy (IGRT) equipment is to reduce and correct inherent errors in external radiotherapy processes. At the present time, there are different IGRT systems available, but here we will refer exclusively to the kilovoltage cone-beam CT onboard linear accelerator (CBkVCT) and the different aspects that, from a clinical point of view, should be taken into consideration before the implementation of this equipment.

  1. Imaging-Guided Core-Needle Breast Biopsy: Impact of Meditation and Music Interventions on Patient Anxiety, Pain, and Fatigue.

    Science.gov (United States)

    Soo, Mary Scott; Jarosz, Jennifer A; Wren, Anava A; Soo, Adrianne E; Mowery, Yvonne M; Johnson, Karen S; Yoon, Sora C; Kim, Connie; Hwang, E Shelley; Keefe, Francis J; Shelby, Rebecca A

    2016-05-01

    To evaluate the impact of guided meditation and music interventions on patient anxiety, pain, and fatigue during imaging-guided breast biopsy. After giving informed consent, 121 women needing percutaneous imaging-guided breast biopsy were randomized into three groups: (1) guided meditation; (2) music; (3) standard-care control group. During biopsy, the meditation and music groups listened to an audio-recorded, guided, loving-kindness meditation and relaxing music, respectively; the standard-care control group received supportive dialogue from the biopsy team. Immediately before and after biopsy, participants completed questionnaires measuring anxiety (State-Trait Anxiety Inventory Scale), biopsy pain (Brief Pain Inventory), and fatigue (modified Functional Assessment of Chronic Illness Therapy-Fatigue). After biopsy, participants completed questionnaires assessing radiologist-patient communication (modified Questionnaire on the Quality of Physician-Patient Interaction), demographics, and medical history. The meditation and music groups reported significantly greater anxiety reduction (P values pain during biopsy, compared with the music group (P = .03). No significant difference in patient-perceived quality of radiologist-patient communication was noted among groups. Listening to guided meditation significantly lowered biopsy pain during imaging-guided breast biopsy; meditation and music reduced patient anxiety and fatigue without compromising radiologist-patient communication. These simple, inexpensive interventions could improve women's experiences during core-needle breast biopsy. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  2. Robotic system

    Science.gov (United States)

    Ambrose, Robert O. (Inventor)

    2003-01-01

    A robot having a plurality of interconnected sections is disclosed. Each of the sections includes components which are moveable relative to components of an adjacent section. A plurality of electric motors are operably connected to at least two of said relatively moveable components to effect relative movement. A fitted, removable protective covering surrounds the sections to protect the robot.

  3. Delta robot

    NARCIS (Netherlands)

    Herder, J.L.; Van der Wijk, V.

    2010-01-01

    The invention relates to a delta robot comprising a stationary base (2) and a movable platform (3) that is connected to the base with three chains of links (4,5,6), and comprising a balancing system incorporating at least one pantograph (7) for balancing the robot's center of mass, wherein the at le

  4. Robotics 101

    Science.gov (United States)

    Sultan, Alan

    2011-01-01

    Robots are used in all kinds of industrial settings. They are used to rivet bolts to cars, to move items from one conveyor belt to another, to gather information from other planets, and even to perform some very delicate types of surgery. Anyone who has watched a robot perform its tasks cannot help but be impressed by how it works. This article…

  5. Delta robot

    NARCIS (Netherlands)

    Herder, J.L.; Van der Wijk, V.

    2010-01-01

    The invention relates to a delta robot comprising a stationary base (2) and a movable platform (3) that is connected to the base with three chains of links (4,5,6), and comprising a balancing system incorporating at least one pantograph (7) for balancing the robot's center of mass, wherein the at le

  6. Robotic environments

    NARCIS (Netherlands)

    Bier, H.H.

    2011-01-01

    Technological and conceptual advances in fields such as artificial intelligence, robotics, and material science have enabled robotic architectural environments to be implemented and tested in the last decade in virtual and physical prototypes. These prototypes are incorporating sensing-actuating mec

  7. Toxicity after post-prostatectomy image-guided intensity-modulated radiotherapy using Australian guidelines.

    Science.gov (United States)

    Chin, Stephen; Aherne, Noel J; Last, Andrew; Assareh, Hassan; Shakespeare, Thomas P

    2017-06-17

    We evaluated single institution toxicity outcomes after post-prostatectomy radiotherapy (PPRT) via image-guided intensity-modulated radiation therapy (IG-IMRT) with implanted fiducial markers following national eviQ guidelines, for which late toxicity outcomes have not been published. Prospectively collected toxicity data were retrospectively reviewed for 293 men who underwent 64-66 Gy IG-IMRT to the prostate bed between 2007 and 2015. Median follow-up after PPRT was 39 months. Baseline grade ≥2 genitourinary (GU), gastrointestinal (GI) and sexual toxicities were 20.5%, 2.7% and 43.7%, respectively, reflecting ongoing toxicity after radical prostatectomy. Incidence of new (compared to baseline) acute grade ≥2 GU and GI toxicity was 5.8% and 10.6%, respectively. New late grade ≥2 GU, GI and sexual toxicity occurred in 19.1%, 4.7% and 20.2%, respectively. However, many patients also experienced improvements in toxicities. For this reason, prevalence of grade ≥2 GU, GI and sexual toxicities 4 years after PPRT was similar to or lower than baseline (21.7%, 2.6% and 17.4%, respectively). There were no grade ≥4 toxicities. Post-prostatectomy IG-IMRT using Australian contouring guidelines appears to have tolerable acute and late toxicity. The 4-year prevalence of grade ≥2 GU and GI toxicity was virtually unchanged compared to baseline, and sexual toxicity improved over baseline. This should reassure radiation oncologists following these guidelines. Late toxicity rates of surgery and PPRT are higher than following definitive IG-IMRT, and this should be taken into account if patients are considering surgery and likely to require PPRT. © 2017 The Royal Australian and New Zealand College of Radiologists.

  8. Evaluation of a cone beam computed tomography geometry for image guided small animal irradiation.

    Science.gov (United States)

    Yang, Yidong; Armour, Michael; Wang, Ken Kang-Hsin; Gandhi, Nishant; Iordachita, Iulian; Siewerdsen, Jeffrey; Wong, John

    2015-07-01

    The conventional imaging geometry for small animal cone beam computed tomography (CBCT) is that a detector panel rotates around the head-to-tail axis of an imaged animal ('tubular' geometry). Another unusual but possible imaging geometry is that the detector panel rotates around the anterior-to-posterior axis of the animal ('pancake' geometry). The small animal radiation research platform developed at Johns Hopkins University employs the pancake geometry where a prone-positioned animal is rotated horizontally between an x-ray source and detector panel. This study is to assess the CBCT image quality in the pancake geometry and investigate potential methods for improvement. We compared CBCT images acquired in the pancake geometry with those acquired in the tubular geometry when the phantom/animal was placed upright simulating the conventional CBCT geometry. Results showed signal-to-noise and contrast-to-noise ratios in the pancake geometry were reduced in comparison to the tubular geometry at the same dose level. But the overall spatial resolution within the transverse plane of the imaged cylinder/animal was better in the pancake geometry. A modest exposure increase to two folds in the pancake geometry can improve image quality to a level close to the tubular geometry. Image quality can also be improved by inclining the animal, which reduces streak artifacts caused by bony structures. The major factor resulting in the inferior image quality in the pancake geometry is the elevated beam attenuation along the long axis of the phantom/animal and consequently increased scatter-to-primary ratio in that orientation. Not withstanding, the image quality in the pancake-geometry CBCT is adequate to support image guided animal positioning, while providing unique advantages of non-coplanar and multiple mice irradiation. This study also provides useful knowledge about the image quality in the two very different imaging geometries, i.e. pancake and tubular geometry, respectively.

  9. SU-E-I-39: Molecular Image Guided Cancer Stem Cells Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Abdollahi, H

    2014-06-01

    Purpose: Cancer stem cells resistance to radiation is a problematic issue that has caused a big fail in cancer treatment. Methods: As a primary work, molecular imaging can indicate the main mechanisms of radiation resistance of cancer stem cells. By developing and commissioning new probes and nanomolecules and biomarkers, radiation scientist will able to identify the essential pathways of radiation resistance of cancer stem cells. As the second solution, molecular imaging is a best way to find biological target volume and delineate cancer stem cell tissues. In the other hand, by molecular imaging techniques one can image the treatment response in tumor and also in normal tissue. In this issue, the response of cancer stem cells to radiation during therapy course can be imaged, also the main mechanisms of radiation resistance and finding the best radiation modifiers (sensitizers) can be achieved by molecular imaging modalities. In adaptive radiotherapy the molecular imaging plays a vital role to have higher tumor control probability by delivering high radiation doses to cancer stem cells in any time of treatment. The outcome of a feasible treatment is dependent to high cancer stem cells response to radiation and removing all of which, so a good imaging modality can show this issue and preventing of tumor recurrence and metastasis. Results: Our results are dependent to use of molecular imaging as a new modality in the clinic. We propose molecular imaging as a new radiobiological technique to solve radiation therapy problems due to cancer stem cells. Conclusion: Molecular imaging guided cancer stem cell diagnosis and therapy is a new approach in the field of cancer treatment. This new radiobiological imaging technique should be developed in all clinics as a feasible tool that is more biological than physical imaging.

  10. Determination of effective doses in image-guided radiation therapy system

    Science.gov (United States)

    Pyone, Y. Y.; Suriyapee, S.; Sanghangthum, T.; Oonsiri, S.; Tawonwong, T.

    2016-03-01

    The organ and effective doses in image-guided radiotherapy system are determined in this study. For 2D imaging, incident air kerma (Ki) was measured by 6cc ionization chamber with Accu-Pro dosimeter. The entrance surface air kerma (ESAK) was calculated by multiplying Ki with backscatter factor. The effective dose was calculated by multiplying ESAK with conversion coefficient. For 3D imaging, computed tomography/cone-beam dose index (CTDI/CBDI) measurements were performed by using 100mm pencil ionization chamber with Accu-Pro dosimeter. The dose index in air and in CTDI phantom from planning CT and cone- beam CT were measured. Then, effective dose was calculated by ImPACT software. The effective doses from 2D conventional simulator for anteroposterior and lateral projections were 01 and 0.02mSv for head, 0.15 and 0.16mSv for thorax, 0.22 and 0.21mSv for pelvis, respectively. The effective doses from 3D, planning CT and CBCT, were 3.3 and 0.1mSv for head, 13 and 2.4mSv for thorax and 7.2 and 4.9mSv for pelvis, respectively. Based on 30 fractions of treatment course, total effective dose (3D CT, 2D setup verification and 6 times CBCT) of head, thorax and pelvis were 3.93, 27.71 and 37.03mSv, respectively. Therefore, IGRT should be administered with significant parameters to reduce the dose.

  11. Diabetic mastopathy: Imaging features and the role of image-guided biopsy in its diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Hyeon; Kim, Eun Kyung; Kim, Min Jung; Moon, Hee Jung; Yoon, Jung Hyun [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-03-15

    The goal of this study was to evaluate the imaging features of diabetic mastopathy (DMP) and the role of image-guided biopsy in its diagnosis. Two experienced radiologists retrospectively reviewed the mammographic and sonographic images of 19 pathologically confirmed DMP patients. The techniques and results of the biopsies performed in each patient were also reviewed. Mammograms showed negative findings in 78% of the patients. On ultrasonography (US), 13 lesions were seen as masses and six as non-mass lesions. The US features of the mass lesions were as follows: irregular shape (69%), oval shape (31%), indistinct margin (69%), angular margin (15%), microlobulated margin (8%), well-defined margin (8%), heterogeneous echogenicity (62%), hypoechoic echogenicity (38%), posterior shadowing (92%), parallel orientation (100%), the absence of calcifications (100%), and the absence of vascularity (100%). Based on the US findings, 17 lesions (89%) were classified as Breast Imaging Reporting and Data System category 4 and two (11%) as category 3. US-guided core biopsy was performed in 18 patients, and 10 (56%) were diagnosed with DMP on that basis. An additional vacuum-assisted biopsy was performed in seven patients and all were diagnosed with DMP. The US features of DMP were generally suspicious for malignancy, whereas the mammographic findings were often negative or showed only focal asymmetry. Core biopsy is an adequate method for initial pathological diagnosis. However, since it yields non-diagnostic results in a considerable number of cases, the evaluation of correlations between imaging and pathology plays an important role in the diagnostic process.

  12. Image Guided Clinical Correlation of CDH and Calve-Legg-Perthes Disease

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Herischi

    2011-05-01

    Full Text Available Background/Objective: Anatomic condition and"nvascularization of the femoral head leads to Calve-"nLegg-Perthes disease (avascular necrosis in children"nand primary condition of acetabulum and coverage"nof hip joint as a defect, cause CDH or congenital"ndislocation of the hip joint. Early diagnosis of these"ndiseases in clinic, confirmation by imaging (US, Xray,"nX-ray CT and MRI help better treatment and less"ncomplication or sequel."nPatients and Methods: By two decade evaluation and"ntreatment we used clinical assessments by pediatric"northopedic surgeons and radiologic examinations like"nfrog-leg, AP X-rays, ultrasound examinations, 2D"nand 3D X-ray CT and 1.5 tesla MR-machine images."nTreatments were with fixation (using cast and elizarov"nvariant fixators, surgery and controlling by imaging."nResults: Ultrasound and MRI were the best methods"nin diagnosis, image guided treatment (medical or"nsurgical and treatment controlling. Many patients"nare treated with minor complications. Complications"nare rare in CDH but some complications have been"nmentioned for CLP disease."nConclusion: Image guidance in diagnosis and treatment"nalso treatment control of pediatric CDH and CLP"ndisease give the pediatric orthopedic surgeon a good"noutcome of the disease and its treatment. Ultrasound"nand MRI using highly sophisticated probes, coils and"nprotocols with new machines gives us the best result"nin diagnosis, treatment and post-op controls.

  13. Swallowable capsule with air channel for improved image-guided cancer detection in the esophagus

    Science.gov (United States)

    Seibel, Eric J.; Melville, C. David; Lung, Jonathan K. C.; Babchanik, Alexander P.; Lee, Cameron M.; Johnston, Richard S.; Dominitz, Jason A.

    2009-02-01

    A new type of endoscope has been developed and tested in the human esophagus, a tethered-capsule endoscope (TCE) that requires no sedation for oral ingestion and esophageal inspection. The TCE uses scanned red, green, and blue laser light to image the upper digestive tract using a swallowable capsule of 6.4mm in diameter and 18mm in length on a 1.4mm diameter tether. The TCE has been modified for image-guided interventions in the lower esophagus, specifically for more effective detection and measurement of the extent of Barrett's esophagus, a precursor to esophageal cancer. Three modifications have been tested in vivo: (1) weighting the capsule so it is negatively buoyant in water, (2) increasing the frame rate of 500-line images to 30 Hz (video rate), and (3) adding a 1.0mm inner diameter working channel alongside the tether for distending the lower esophagus with air pressure during endoscopy. All three modifications proved effective for more clearly visualizing the lower esophagus in the first few human subjects. The air channel was especially useful because it did not change tolerability in the first subject for unsedated endoscopy and the air easily removed bubbles obscuring tissue from the field of view. The air provided a non-invasive intervention by stimulating the mechanosensor of the lower esophageal sphincter at the precise time that the TCE was positioned for most informative imaging. All three TCE modifications proved successful for improved visualization of esophageal pathology, such as suspected Barrett's esophagus, without the use of sedation.

  14. Localization and registration accuracy in image guided neurosurgery: a clinical study.

    Science.gov (United States)

    Shamir, Reuben R; Joskowicz, Leo; Spektor, Sergey; Shoshan, Yigal

    2009-01-01

    To measure and compare the clinical localization and registration errors in image-guided neurosurgery, with the purpose of revising current assumptions. Twelve patients who underwent brain surgeries with a navigation system were randomly selected. A neurosurgeon localized and correlated the landmarks on preoperative MRI images and on the intraoperative physical anatomy with a tracked pointer. In the laboratory, we generated 612 scenarios in which one landmark pair was defined as the target and the remaining ones were used to compute the registration transformation. Four errors were measured: (1) fiducial localization error (FLE); (2) target registration error (TRE); (3) fiducial registration error (FRE); (4) Fitzpatrick's target registration error estimation (F-TRE). We compared the different errors and computed their correlation. The image and physical FLE ranges were 0.5-2.0 and 1.6-3.0 mm, respectively. The measured TRE, FRE and F-TRE were 4.1 +/- 1.6, 3.9 +/- 1.2, and 3.7 +/- 2.2 mm, respectively. Low correlations of 0.19 and 0.37 were observed between the FRE and TRE and between the F-TRE and the TRE, respectively. The differences of the FRE and F-TRE from the TRE were 1.3 +/- 1.0 mm (max = 5.5 mm) and 1.3 +/- 1.2 mm (max = 7.3 mm), respectively. Contrary to common belief, the FLE presents significant variations. Moreover, both the FRE and the F-TRE are poor indicators of the TRE in image-to-patient registration.

  15. Accuracy Considerations in Image-guided Cardiac Interventions: Experience and Lessons Learned

    Science.gov (United States)

    Linte, Cristian A.; Lang, Pencilla; Rettmann, Maryam E.; Cho, Daniel S.; Holmes, David R.; Robb, Richard A.; Peters, Terry M.

    2014-01-01

    Motivation Medical imaging and its application in interventional guidance has revolutionized the development of minimally invasive surgical procedures leading to reduced patient trauma, fewer risks, and shorter recovery times. However, a frequently posed question with regards to an image guidance system is “how accurate is it?” On one hand, the accuracy challenge can be posed in terms of the tolerable clinical error associated with the procedure; on the other hand, accuracy is bound by the limitations of the system’s components, including modeling, patient registration, and surgical instrument tracking, all of which ultimately impact the overall targeting capabilities of the system. Methods While these processes are not unique to any interventional specialty, this paper discusses them in the context of two different cardiac image-guidance platforms: a model-enhanced ultrasound platform for intracardiac interventions and a prototype system for advanced visualization in image-guided cardiac ablation therapy. Results Pre-operative modeling techniques involving manual, semi-automatic and registration-based segmentation are discussed. The performance and limitations of clinically feasible approaches for patient registration evaluated both in the laboratory and operating room are presented. Our experience with two different magnetic tracking systems for instrument and ultrasound transducer localization is reported. Ultimately, the overall accuracy of the systems is discussed based on both in vitro and preliminary in vivo experience. Conclusion While clinical accuracy is specific to a particular patient and procedure and vastly dependent on the surgeon’s experience, the system’s engineering limitations are critical to determine whether the clinical requirements can be met. PMID:21671097

  16. Dual source and dual detector arrays tetrahedron beam computed tomography for image guided radiotherapy

    Science.gov (United States)

    Kim, Joshua; Lu, Weiguo; Zhang, Tiezhi

    2014-02-01

    Cone-beam computed tomography (CBCT) is an important online imaging modality for image guided radiotherapy. But suboptimal image quality and the lack of a real-time stereoscopic imaging function limit its implementation in advanced treatment techniques, such as online adaptive and 4D radiotherapy. Tetrahedron beam computed tomography (TBCT) is a novel online imaging modality designed to improve on the image quality provided by CBCT. TBCT geometry is flexible, and multiple detector and source arrays can be used for different applications. In this paper, we describe a novel dual source-dual detector TBCT system that is specially designed for LINAC radiation treatment machines. The imaging system is positioned in-line with the MV beam and is composed of two linear array x-ray sources mounted aside the electrical portal imaging device and two linear arrays of x-ray detectors mounted below the machine head. The detector and x-ray source arrays are orthogonal to each other, and each pair of source and detector arrays forms a tetrahedral volume. Four planer images can be obtained from different view angles at each gantry position at a frame rate as high as 20 frames per second. The overlapped regions provide a stereoscopic field of view of approximately 10-15 cm. With a half gantry rotation, a volumetric CT image can be reconstructed having a 45 cm field of view. Due to the scatter rejecting design of the TBCT geometry, the system can potentially produce high quality 2D and 3D images with less radiation exposure. The design of the dual source-dual detector system is described, and preliminary results of studies performed on numerical phantoms and simulated patient data are presented.

  17. Development of a spherically focused phased array transducer for ultrasonic image-guided hyperthermia

    Science.gov (United States)

    Liu, Jingfei; Foiret, Josquin; Stephens, Douglas N.; Le Baron, Olivier; Ferrara, Katherine W.

    2016-07-01

    A 1.5 MHz prolate spheroidal therapeutic array with 128 circular elements was designed to accommodate standard imaging arrays for ultrasonic image-guided hyperthermia. The implementation of this dual-array system integrates real-time therapeutic and imaging functions with a single ultrasound system (Vantage 256, Verasonics). To facilitate applications involving small animal imaging and therapy the array was designed to have a beam depth of field smaller than 3.5 mm and to electronically steer over distances greater than 1 cm in both the axial and lateral directions. In order to achieve the required f number of 0.69, 1-3 piezocomposite modules were mated within the transducer housing. The performance of the prototype array was experimentally evaluated with excellent agreement with numerical simulation. A focal volume (2.70 mm (axial)  ×  0.65 mm (transverse)  ×  0.35 mm (transverse)) defined by the  -6 dB focal intensity was obtained to address the dimensions needed for small animal therapy. An electronic beam steering range defined by the  -3 dB focal peak intensity (17 mm (axial)  ×  14 mm (transverse)  ×  12 mm (transverse)) and  -8 dB lateral grating lobes (24 mm (axial)  ×  18 mm (transverse)  ×  16 mm (transverse)) was achieved. The combined testing of imaging and therapeutic functions confirmed well-controlled local heating generation and imaging in a tissue mimicking phantom. This dual-array implementation offers a practical means to achieve hyperthermia and ablation in small animal models and can be incorporated within protocols for ultrasound-mediated drug delivery.

  18. Fast CT-CT fluoroscopy registration with respiratory motion compensation for image-guided lung intervention

    Science.gov (United States)

    Su, Po; Xue, Zhong; Lu, Kongkuo; Yang, Jianhua; Wong, Stephen T.

    2012-02-01

    CT-fluoroscopy (CTF) is an efficient imaging method for guiding percutaneous lung interventions such as biopsy. During CTF-guided biopsy procedure, four to ten axial sectional images are captured in a very short time period to provide nearly real-time feedback to physicians, so that they can adjust the needle as it is advanced toward the target lesion. Although popularly used in clinics, this traditional CTF-guided intervention procedure may require frequent scans and cause unnecessary radiation exposure to clinicians and patients. In addition, CTF only generates limited slices of images and provides limited anatomical information. It also has limited response to respiratory movements and has narrow local anatomical dynamics. To better utilize CTF guidance, we propose a fast CT-CTF registration algorithm with respiratory motion estimation for image-guided lung intervention using electromagnetic (EM) guidance. With the pre-procedural exhale and inhale CT scans, it would be possible to estimate a series of CT images of the same patient at different respiratory phases. Then, once a CTF image is captured during the intervention, our algorithm can pick the best respiratory phase-matched 3D CT image and performs a fast deformable registration to warp the 3D CT toward the CTF. The new 3D CT image can be used to guide the intervention by superimposing the EM-guided needle location on it. Compared to the traditional repetitive CTF guidance, the registered CT integrates both 3D volumetric patient data and nearly real-time local anatomy for more effective and efficient guidance. In this new system, CTF is used as a nearly real-time sensor to overcome the discrepancies between static pre-procedural CT and the patient's anatomy, so as to provide global guidance that may be supplemented with electromagnetic (EM) tracking and to reduce the number of CTF scans needed. In the experiments, the comparative results showed that our fast CT-CTF algorithm can achieve better registration

  19. Multiphoton microscopy and image guided light activated therapy using nanomaterials (Conference Presentation)

    Science.gov (United States)

    Prasad, Paras N.

    2017-02-01

    This talk will focus on design and applications of nanomaterials exhibiting strong multiphoton upconversion for multiphoton microscopy as well as for image-guided and light activated therapy .1-3 Such processes can occur by truly nonlinear optical interactions proceeding through virtual intermediate states or by stepwise coupled linear excitations through real intermediate states. Multiphoton processes in biocompatible multifunctional nanoparticles allow for 3D deep tissue imaging. In addition, they can produce in-situ photon conversion of deep tissue penetrating near IR light into a needed shorter wavelength light for photo-activated therapy at a targeted site, thus overcoming the limited penetration of UV or visible light into biological media. We are using near IR emitters such as silicon quantum dots which also exhibit strong multiphoton excitation for multiphoton microscopy. Another approach involves nonlinear nanocrystals such as ZnO which can produce four wave mixing, sum frequency generation as well as second harmonic generation to convert a deep tissue penetrating Near IR light at the targeted biological site to a desired shorter wavelength light suitable for bio imaging or activation of a therapy. We have utilized this approach to activate a photosensitizer for photodynamic therapy. Yet another type of upconversion materials is rare-earth ion doped optical nanotransformers which transform a Near IR (NIR) light from an external source by sequential single photon absorption, in situ and on demand, to a needed wavelength. Applications of these nanotransformers in multiphoton photoacoustic imaging will also be presented. An exciting direction pursued by us using these multiphoton nanoparticles, is functional imaging of brain. Simultaneously, they can effect optogenetics for regioselective stimulation of neurons for providing an effective intervention/augmentation strategy to enhance the cognitive state and lead to a foundation for futuristic vision of super

  20. Incremental Learning With Selective Memory (ILSM): Towards Fast Prostate Localization for Image Guided Radiotherapy

    Science.gov (United States)

    Gao, Yaozong; Zhan, Yiqiang

    2015-01-01

    Image-guided radiotherapy (IGRT) requires fast and accurate localization of the prostate in 3-D treatment-guided radiotherapy, which is challenging due to low tissue contrast and large anatomical variation across patients. On the other hand, the IGRT workflow involves collecting a series of computed tomography (CT) images from the same patient under treatment. These images contain valuable patient-specific information yet are often neglected by previous works. In this paper, we propose a novel learning framework, namely incremental learning with selective memory (ILSM), to effectively learn the patient-specific appearance characteristics from these patient-specific images. Specifically, starting with a population-based discriminative appearance model, ILSM aims to “personalize” the model to fit patient-specific appearance characteristics. The model is personalized with two steps: backward pruning that discards obsolete population-based knowledge and forward learning that incorporates patient-specific characteristics. By effectively combining the patient-specific characteristics with the general population statistics, the incrementally learned appearance model can localize the prostate of a specific patient much more accurately. This work has three contributions: 1) the proposed incremental learning framework can capture patient-specific characteristics more effectively, compared to traditional learning schemes, such as pure patient-specific learning, population-based learning, and mixture learning with patient-specific and population data; 2) this learning framework does not have any parametric model assumption, hence, allowing the adoption of any discriminative classifier; and 3) using ILSM, we can localize the prostate in treatment CTs accurately (DSC ∼0.89) and fast (∼4 s), which satisfies the real-world clinical requirements of IGRT. PMID:24495983

  1. Transarterial Fiducial Marker Placement for Image-guided Proton Therapy for Malignant Liver Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Ohta, Kengo, E-mail: yesterday.is.yesterday@gmail.com; Shimohira, Masashi, E-mail: mshimohira@gmail.com [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan); Sasaki, Shigeru, E-mail: ssasaki916@yahoo.co.jp; Iwata, Hiromitsu, E-mail: h-iwa-ncu@nifty.com; Nishikawa, Hiroko, E-mail: piroko1018@gmail.com; Ogino, Hiroyuki, E-mail: oginogio@gmail.com; Hara, Masaki, E-mail: mhara@med.nagoya-cu.ac.jp [Nagoya City West Medical Center, Department of Radiation Oncology, Nagoya Proton Therapy Center (Japan); Hashizume, Takuya, E-mail: tky300@gmail.com; Shibamoto, Yuta, E-mail: yshiba@med.nagoya-cu.ac.jp [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan)

    2015-10-15

    PurposeThe aim of this study is to analyze the technical and clinical success rates and safety of transarterial fiducial marker placement for image-guided proton therapy for malignant liver tumors.Methods and MaterialsFifty-five patients underwent this procedure as an interventional treatment. Five patients had 2 tumors, and 4 tumors required 2 markers each, so the total number of procedures was 64. The 60 tumors consisted of 46 hepatocellular carcinomas and 14 liver metastases. Five-mm-long straight microcoils of 0.018 inches in diameter were used as fiducial markers and placed in appropriate positions for each tumor. We assessed the technical and clinical success rates of transarterial fiducial marker placement, as well as the complications associated with it. Technical success was defined as the successful delivery and placement of the fiducial coil, and clinical success was defined as the completion of proton therapy.ResultsAll 64 fiducial coils were successfully installed, so the technical success rate was 100 % (64/64). Fifty-four patients underwent proton therapy without coil migration. In one patient, proton therapy was not performed because of obstructive jaundice due to bile duct invasion by hepatocellular carcinoma. Thus, the clinical success rate was 98 % (54/55). Slight bleeding was observed in one case, but it was stopped immediately and then observed. None of the patients developed hepatic infarctions due to fiducial marker migration.ConclusionTransarterial fiducial marker placement appears to be a useful and safe procedure for proton therapy for malignant liver tumors.

  2. Deep architecture neural network-based real-time image processing for image-guided radiotherapy.

    Science.gov (United States)

    Mori, Shinichiro

    2017-08-01

    To develop real-time image processing for image-guided radiotherapy, we evaluated several neural network models for use with different imaging modalities, including X-ray fluoroscopic image denoising. Setup images of prostate cancer patients were acquired with two oblique X-ray fluoroscopic units. Two types of residual network were designed: a convolutional autoencoder (rCAE) and a convolutional neural network (rCNN). We changed the convolutional kernel size and number of convolutional layers for both networks, and the number of pooling and upsampling layers for rCAE. The ground-truth image was applied to the contrast-limited adaptive histogram equalization (CLAHE) method of image processing. Network models were trained to keep the quality of the output image close to that of the ground-truth image from the input image without image processing. For image denoising evaluation, noisy input images were used for the training. More than 6 convolutional layers with convolutional kernels >5×5 improved image quality. However, this did not allow real-time imaging. After applying a pair of pooling and upsampling layers to both networks, rCAEs with >3 convolutions each and rCNNs with >12 convolutions with a pair of pooling and upsampling layers achieved real-time processing at 30 frames per second (fps) with acceptable image quality. Use of our suggested network achieved real-time image processing for contrast enhancement and image denoising by the use of a conventional modern personal computer. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  3. Accuracy of image-guided surgical navigation using near infrared (NIR) optical tracking

    Science.gov (United States)

    Jakubovic, Raphael; Farooq, Hamza; Alarcon, Joseph; Yang, Victor X. D.

    2015-03-01

    Spinal surgery is particularly challenging for surgeons, requiring a high level of expertise and precision without being able to see beyond the surface of the bone. Accurate insertion of pedicle screws is critical considering perforation of the pedicle can result in profound clinical consequences including spinal cord, nerve root, arterial injury, neurological deficits, chronic pain, and/or failed back syndrome. Various navigation systems have been designed to guide pedicle screw fixation. Computed tomography (CT)-based image guided navigation systems increase the accuracy of screw placement allowing for 3- dimensional visualization of the spinal anatomy. Current localization techniques require extensive preparation and introduce spatial deviations. Use of near infrared (NIR) optical tracking allows for realtime navigation of the surgery by utilizing spectral domain multiplexing of light, greatly enhancing the surgeon's situation awareness in the operating room. While the incidence of pedicle screw perforation and complications have been significantly reduced with the introduction of modern navigational technologies, some error exists. Several parameters have been suggested including fiducial localization and registration error, target registration error, and angular deviation. However, many of these techniques quantify error using the pre-operative CT and an intra-operative screenshot without assessing the true screw trajectory. In this study we quantified in-vivo error by comparing the true screw trajectory to the intra-operative trajectory. Pre- and post- operative CT as well as intra-operative screenshots were obtained for a cohort of patients undergoing spinal surgery. We quantified entry point error and angular deviation in the axial and sagittal planes.

  4. Image-guided linear accelerator-based spinal radiosurgery for hemangioblastoma.

    Science.gov (United States)

    Selch, Michael T; Tenn, Steve; Agazaryan, Nzhde; Lee, Steve P; Gorgulho, Alessandra; De Salles, Antonio A F

    2012-01-01

    To retrospectively review the efficacy and safety of image-guided linear accelerator-based radiosurgery for spinal hemangioblastomas. Between August 2004 and September 2010, nine patients with 20 hemangioblastomas underwent spinal radiosurgery. Five patients had von Hipple-Lindau disease. Four patients had multiple tumors. Ten tumors were located in the thoracic spine, eight in the cervical spine, and two in the lumbar spine. Tumor volume varied from 0.08 to 14.4 cc (median 0.72 cc). Maximum tumor dimension varied from 2.5 to 24 mm (median 10.5 mm). Radiosurgery was performed with a dedicated 6 MV linear accelerator equipped with a micro-multileaf collimator. Median peripheral tumor dose and prescription isodose were 12 Gy and 90%, respectively. Image guidance was performed by optical tracking of infrared reflectors, fusion of oblique radiographs with dynamically reconstructed digital radiographs, and automatic patient positioning. Follow-up varied from 14 to 86 months (median 51 months). Kaplan-Meier estimated 4-year overall and solid tumor local control rates were 90% and 95%, respectively. One tumor progressed 12 months after treatment and a new cyst developed 10 months after treatment in another tumor. There has been no clinical or imaging evidence for spinal cord injury. Results of this limited experience indicate linear accelerator-based radiosurgery is safe and effective for spinal cord hemangioblastomas. Longer follow-up is necessary to confirm the durability of tumor control, but these initial results imply linear accelerator-based radiosurgery may represent a therapeutic alternative to surgery for selected patients with spinal hemangioblastomas.

  5. Image-guided smart laser system for precision implantation of cells in cartilage

    Science.gov (United States)

    Katta, Nitesh; Rector, John A.; Gardner, Michael R.; McElroy, Austin B.; Choy, Kevin C.; Crosby, Cody; Zoldan, Janet; Milner, Thomas E.

    2017-03-01

    State-of-the-art treatment for joint diseases like osteoarthritis focus on articular cartilage repair/regeneration by stem cell implantation therapy. However, the technique is limited by a lack of precision in the physician's imaging and cell deposition toolkit. We describe a novel combination of high-resolution, rapid scan-rate optical coherence tomography (OCT) alongside a short-pulsed nanosecond thulium (Tm) laser for precise cell seeding in cartilage. The superior beam quality of thulium lasers and wavelength of operation 1940 nm offers high volumetric tissue removal rates and minimizes the residual thermal footprint. OCT imaging enables targeted micro-well placement, precise cell deposition, and feature contrast. A bench-top system is constructed using a 15 W, 1940 nm, nanosecond-pulsed Tm fiber laser (500 μJ pulse energy, 100 ns pulse duration, 30kHz repetition rate) for removing tissue, and a swept source laser (1310 ± 70 nm, 100 kHz sweep rate) for OCT imaging, forming a combined Tm/OCT system - a "smart laser knife". OCT assists the smart laser knife user in characterizing cartilage to inform micro-well placement. The Tm laser creates micro-wells (2.35 mm diameter length, 1.5 mm width, 300 μm deep) and micro-incisions (1 mm wide, 200 μm deep) while OCT image-guidance assists and demonstrates this precision cutting and cell deposition with real-time feedback. To test micro-well creation and cell deposition protocol, gelatin phantoms are constructed mimicking cartilage optical properties and physiological structure. Cell viability is then assessed to illustrate the efficacy of the hydrogel deposition. Automated OCT feedback is demonstrated for cutting procedures to avoid important surface/subsurface structures. This bench-top smart laser knife system described here offers a new image-guided approach to precise stem cell seeding that can enhance the efficacy of articular cartilage repair.

  6. Incremental learning with selective memory (ILSM): towards fast prostate localization for image guided radiotherapy.

    Science.gov (United States)

    Gao, Yaozong; Zhan, Yiqiang; Shen, Dinggang

    2014-02-01

    Image-guided radiotherapy (IGRT) requires fast and accurate localization of the prostate in 3-D treatment-guided radiotherapy, which is challenging due to low tissue contrast and large anatomical variation across patients. On the other hand, the IGRT workflow involves collecting a series of computed tomography (CT) images from the same patient under treatment. These images contain valuable patient-specific information yet are often neglected by previous works. In this paper, we propose a novel learning framework, namely incremental learning with selective memory (ILSM), to effectively learn the patient-specific appearance characteristics from these patient-specific images. Specifically, starting with a population-based discriminative appearance model, ILSM aims to "personalize" the model to fit patient-specific appearance characteristics. The model is personalized with two steps: backward pruning that discards obsolete population-based knowledge and forward learning that incorporates patient-specific characteristics. By effectively combining the patient-specific characteristics with the general population statistics, the incrementally learned appearance model can localize the prostate of a specific patient much more accurately. This work has three contributions: 1) the proposed incremental learning framework can capture patient-specific characteristics more effectively, compared to traditional learning schemes, such as pure patient-specific learning, population-based learning, and mixture learning with patient-specific and population data; 2) this learning framework does not have any parametric model assumption, hence, allowing the adoption of any discriminative classifier; and 3) using ILSM, we can localize the prostate in treatment CTs accurately (DSC  ∼ 0.89 ) and fast (  ∼ 4 s), which satisfies the real-world clinical requirements of IGRT.

  7. Learning curve of 3D fluoroscopy image-guided pedicle screw placement in the thoracolumbar spine.

    Science.gov (United States)

    Ryang, Yu-Mi; Villard, Jimmy; Obermüller, Thomas; Friedrich, Benjamin; Wolf, Petra; Gempt, Jens; Ringel, Florian; Meyer, Bernhard

    2015-03-01

    During the past decade, a disproportionate increase of spinal fusion procedures has been observed. Along with this trend, image-guided spine surgery has been experiencing a renaissance in the recent years. A wide range of different navigation systems are available on the market today. However, only few published studies assess the learning curves concerning these new spinal navigation techniques. So far, a study on the learning curve for intraoperative three-dimensional fluoroscopy (3DFL)-navigated pedicle screw (PS) placement is still lacking. The purpose of the study was to analyze the learning curve for 3DFL-navigated thoracolumbar PS placement. The study design included a prospective case series. A cohort of 145 patients were recruited from January 2011 to June 2012. The outcome measures were duration of intraoperative 3D scans, PS placement, PS accuracy on postoperative computed tomography (CT) scans, and PS-related revisions and complications. From the introduction of spinal navigation to our department in January 2011 until June 2012, the learning curve for the duration of intraoperative 3D scan acquisition (navigation or control scan) and placement time per screw, intraoperative screw revisions, screw-related complications, revision surgeries, and PS accuracy on postoperative CT scans were assessed in 145 patients undergoing dorsal navigated instrumentation for 928 PS (736 lumbosacral and 192 thoracic). The observed time span was divided into four intervals. Results of the second, third, and last periods were compared with the first (reference) period, respectively. The mean navigation 3D scan time decreased (first and fourth periods) from 15.4±7.8 (range, 4-40) to 8.4±3.3 (3-15) minutes (plearning effect was found with respect to intraoperative screw revisions. There was one revision surgery. We could demonstrate significant learning effects for 3DFL-navigated PS placement with regard to intraoperative 3D scan acquisition, PS placement time, and PS

  8. Contribution of image-guided adaptive brachytherapy to pelvic nodes treatment in locally advanced cervical cancer.

    Science.gov (United States)

    Bacorro, Warren; Dumas, Isabelle; Levy, Antonin; Rivin Del Campo, Eleonor; Canova, Charles-Henri; Felefly, Tony; Huertas, Andres; Marsolat, Fanny; Haie-Meder, Christine; Chargari, Cyrus; Mazeron, Renaud

    With the increasing use of simultaneous integrated boost in the treatment of cervical cancer, there is a need to anticipate the brachytherapy (BT) contribution at the level of the pathologic pelvic lymph nodes. This study aimed to report the dose delivered at their level during BT. Patients with pelvic nodal involvement and treated with a combination of chemoradiation followed by image-guided adaptive pulsed-dose-rate BT were selected. On per BT three-dimensional images, pelvic lymphadenopathies were delineated, without planning aim. For the purposes of the study, D100, D98, D90, and D50 were reviewed and converted in 2-Gy equivalent doses, using the linear quadratic model with an α/β of 10 Gy. Ninety-one patients were identified, allowing evaluation at the level of 226 lymphadenopathies. The majority of them were external iliac (48%), followed by common iliac (25%), and internal iliac (16%) regions. The 2-Gy equivalent doses D98 were 4.4 ± 1.9 Gy, 5.4 ± 3.1 Gy, and 4.3 ± 2.1 Gy for the obturator, internal iliac, and external iliac, respectively, and 2.8 ± 2.5 Gy for the common iliac. The contribution to the common iliac nodes was significantly lower than the one of external and internal iliac (p < 0.001). BT significantly contributes to the treatment of pelvic nodes at the level of approximately 5 Gy in the internal, external, and obturator areas and 2.5 Gy in the common iliac, allowing the anticipation of nodal boost with the simultaneous integrated boost technique. However, important individual variations have been observed, and evaluation of the genuine BT contribution should be recommended. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  9. Toxicity after intensity-modulated, image-guided radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Flentje, Michael [Dept. of Radiotherapy, Univ. Hospital Wuerzburg (Germany); Guckenberger, Matthias; Ok, Sami; Polat, Buelent; Sweeney, Reinhart A.

    2010-10-15

    Purpose: To evaluate toxicity after dose-escalated radiotherapy for prostate cancer using intensity-modulated treatment planning (IMRT) and image-guided treatment (IGRT) delivery. Patients and Methods: 100 patients were treated with simultaneous integrated boost (SIB) IMRT for prostate cancer: doses of 76.23 Gy and 60 Gy in 33 fractions were prescribed to the prostate and the seminal vesicles, respectively, for intermediate- and high-risk patients (n = 74). The total dose was 73.91 Gy in 32 fractions for low-risk patients and after transurethral resection of the prostate (n = 26). The pelvic lymphatics were treated with 46 Gy in 25 fractions in patients with high risk of lymph node metastases using an SIB to the prostate (n = 25). IGRT was practiced with cone-beam computed tomography. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated prospectively (CTCAE v3.0). Results: Treatment was completed as planned by all patients. Acute GI and GU toxicity grade {>=} 2 was observed in 12% and 42% of the patients, respectively, with 4% suffering from GU toxicity grade 3. 6 weeks after treatment, the incidence of acute toxicity grade {>=} 2 had decreased to 12%. With a median follow-up of 26 months, late GI and GU toxicity grade {>=} 2 was seen in 1.5% and 7.7% of the patients at 24 months. Four patients developed late toxicity grade 3 (GI n = 1; GU n = 3). Presence of acute GI and GU toxicity was significantly associated with late GI (p = 0.0007) and GU toxicity (p = 0.006). Conclusion: High-dose radiotherapy for prostate cancer using IMRT and IGRT resulted in low rates of acute toxicity and preliminary results of late toxicity are promising. (orig.)

  10. Integration of patient specific modeling and advanced image processing techniques for image-guided neurosurgery

    Science.gov (United States)

    Archip, Neculai; Fedorov, Andriy; Lloyd, Bryn; Chrisochoides, Nikos; Golby, Alexandra; Black, Peter M.; Warfield, Simon K.

    2006-03-01

    A major challenge in neurosurgery oncology is to achieve maximal tumor removal while avoiding postoperative neurological deficits. Therefore, estimation of the brain deformation during the image guided tumor resection process is necessary. While anatomic MRI is highly sensitive for intracranial pathology, its specificity is limited. Different pathologies may have a very similar appearance on anatomic MRI. Moreover, since fMRI and diffusion tensor imaging are not currently available during the surgery, non-rigid registration of preoperative MR with intra-operative MR is necessary. This article presents a translational research effort that aims to integrate a number of state-of-the-art technologies for MRI-guided neurosurgery at the Brigham and Women's Hospital (BWH). Our ultimate goal is to routinely provide the neurosurgeons with accurate information about brain deformation during the surgery. The current system is tested during the weekly neurosurgeries in the open magnet at the BWH. The preoperative data is processed, prior to the surgery, while both rigid and non-rigid registration algorithms are run in the vicinity of the operating room. The system is tested on 9 image datasets from 3 neurosurgery cases. A method based on edge detection is used to quantitatively validate the results. 95% Hausdorff distance between points of the edges is used to estimate the accuracy of the registration. Overall, the minimum error is 1.4 mm, the mean error 2.23 mm, and the maximum error 3.1 mm. The mean ratio between brain deformation estimation and rigid alignment is 2.07. It demonstrates that our results can be 2.07 times more precise then the current technology. The major contribution of the presented work is the rigid and non-rigid alignment of the pre-operative fMRI with intra-operative 0.5T MRI achieved during the neurosurgery.

  11. Retractor-induced brain shift compensation in image-guided neurosurgery

    Science.gov (United States)

    Fan, Xiaoyao; Ji, Songbai; Hartov, Alex; Roberts, David; Paulsen, Keith

    2013-03-01

    In image-guided neurosurgery, intraoperative brain shift significantly degrades the accuracy of neuronavigation that is solely based on preoperative magnetic resonance images (pMR). To compensate for brain deformation and to maintain the accuracy in image guidance achieved at the start of surgery, biomechanical models have been developed to simulate brain deformation and to produce model-updated MR images (uMR) to compensate for brain shift. To-date, most studies have focused on shift compensation at early stages of surgery (i.e., updated images are only produced after craniotomy and durotomy). Simulating surgical events at later stages such as retraction and tissue resection are, perhaps, clinically more relevant because of the typically much larger magnitudes of brain deformation. However, these surgical events are substantially more complex in nature, thereby posing significant challenges in model-based brain shift compensation strategies. In this study, we present results from an initial investigation to simulate retractor-induced brain deformation through a biomechanical finite element (FE) model where whole-brain deformation assimilated from intraoperative data was used produce uMR for improved accuracy in image guidance. Specifically, intensity-encoded 3D surface profiles at the exposed cortical area were reconstructed from intraoperative stereovision (iSV) images before and after tissue retraction. Retractor-induced surface displacements were then derived by coregistering the surfaces and served as sparse displacement data to drive the FE model. With one patient case, we show that our technique is able to produce uMR that agrees well with the reconstructed iSV surface after retraction. The computational cost to simulate retractor-induced brain deformation was approximately 10 min. In addition, our approach introduces minimal interruption to the surgical workflow, suggesting the potential for its clinical application.

  12. IBIS: an OR ready open-source platform for image-guided neurosurgery.

    Science.gov (United States)

    Drouin, Simon; Kochanowska, Anna; Kersten-Oertel, Marta; Gerard, Ian J; Zelmann, Rina; De Nigris, Dante; Bériault, Silvain; Arbel, Tal; Sirhan, Denis; Sadikot, Abbas F; Hall, Jeffery A; Sinclair, David S; Petrecca, Kevin; DelMaestro, Rolando F; Collins, D Louis

    2017-03-01

    Navigation systems commonly used in neurosurgery suffer from two main drawbacks: (1) their accuracy degrades over the course of the operation and (2) they require the surgeon to mentally map images from the monitor to the patient. In this paper, we introduce the Intraoperative Brain Imaging System (IBIS), an open-source image-guided neurosurgery research platform that implements a novel workflow where navigation accuracy is improved using tracked intraoperative ultrasound (iUS) and the visualization of navigation information is facilitated through the use of augmented reality (AR). The IBIS platform allows a surgeon to capture tracked iUS images and use them to automatically update preoperative patient models and plans through fast GPU-based reconstruction and registration methods. Navigation, resection and iUS-based brain shift correction can all be performed using an AR view. IBIS has an intuitive graphical user interface for the calibration of a US probe, a surgical pointer as well as video devices used for AR (e.g., a surgical microscope). The components of IBIS have been validated in the laboratory and evaluated in the operating room. Image-to-patient registration accuracy is on the order of [Formula: see text] and can be improved with iUS to a median target registration error of 2.54 mm. The accuracy of the US probe calibration is between 0.49 and 0.82 mm. The average reprojection error of the AR system is [Formula: see text]. The system has been used in the operating room for various types of surgery, including brain tumor resection, vascular neurosurgery, spine surgery and DBS electrode implantation. The IBIS platform is a validated system that allows researchers to quickly bring the results of their work into the operating room for evaluation. It is the first open-source navigation system to provide a complete solution for AR visualization.

  13. Dual source and dual detector arrays tetrahedron beam computed tomography for image guided radiotherapy.

    Science.gov (United States)

    Kim, Joshua; Lu, Weiguo; Zhang, Tiezhi

    2014-02-01

    Cone-beam computed tomography (CBCT) is an important online imaging modality for image guided radiotherapy. But suboptimal image quality and the lack of a real-time stereoscopic imaging function limit its implementation in advanced treatment techniques, such as online adaptive and 4D radiotherapy. Tetrahedron beam computed tomography (TBCT) is a novel online imaging modality designed to improve on the image quality provided by CBCT. TBCT geometry is flexible, and multiple detector and source arrays can be used for different applications. In this paper, we describe a novel dual source-dual detector TBCT system that is specially designed for LINAC radiation treatment machines. The imaging system is positioned in-line with the MV beam and is composed of two linear array x-ray sources mounted aside the electrical portal imaging device and two linear arrays of x-ray detectors mounted below the machine head. The detector and x-ray source arrays are orthogonal to each other, and each pair of source and detector arrays forms a tetrahedral volume. Four planer images can be obtained from different view angles at each gantry position at a frame rate as high as 20 frames per second. The overlapped regions provide a stereoscopic field of view of approximately 10-15 cm. With a half gantry rotation, a volumetric CT image can be reconstructed having a 45 cm field of view. Due to the scatter rejecting design of the TBCT geometry, the system can potentially produce high quality 2D and 3D images with less radiation exposure. The design of the dual source-dual detector system is described, and preliminary results of studies performed on numerical phantoms and simulated patient data are presented.

  14. Standardization of selection criteria for percutaneous image-guided cryoablation of recurrent soft-tissue sarcomas.

    Science.gov (United States)

    Lippa, N; Sargos, P; Italiano, A; Kind, M; Dallaudière, B; Hauger, O; Cornelis, F

    2014-11-01

    Percutaneous image-guided cryoablation has not been validated for local management of recurrence of soft tissue sarcoma (STS) of the trunk or limbs. This study aims to identify selection criteria for cryoablation in order to standardize indications of this treatment. Between 2000 and 2010, 46 patients (57 tumors) presenting local recurrences of STS of the trunk or limbs and treated following standards of care were selected from our institutional database. Eligibility for cryoablation was assessed by two radiologists according to predefined criteria: maximal diameter size of the tumor ≤10cm, distance to skin >5mm, distance to neurovascular structures 3mm at least, absence of articular involvement and planned cryoablation covering the entire lesion volume. Characteristics and outcomes were compared. There was nearly perfect agreement for all criteria (k coefficient ranging from 0.83 to 0.98) between both readers. A subgroup of 13patients was identified as eligible for cryoablation. Locations to the trunk, pelvic girdle or shoulder were significantly more present in the cryoablation group (P=0.002). In this group, tumors were mainly located deeply (P=0.002) with great axes ≤5cm (P=0.044). High local tumor aggressiveness (P=0.016) and differentiated myxoid liposarcoma or myxofibrosarcoma (P=0.007) were more frequent in the eligible group. Based on these criteria, two groups of patients with local relapse of STS can be identified. These results may improve the standardization of selection of patients who could be candidates for cryoablation. Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  15. Cirurgia estereotáxica guiada para angiomas cavernosos Stereotactic-guided surgery for cavernous angioma

    Directory of Open Access Journals (Sweden)

    MURILO S. MENESES

    2000-03-01

    Full Text Available Os angiomas cavernosos intracerebrais são lesões que podem causar hemorragias, crises convulsivas e déficits neurológicos. Essa patologia passou a ter diagnóstico mais precoce com o advento da ressonância magnética. A remoção radical por cirurgia é o melhor método de tratamento. Devido a frequente localização subcortical ou profunda, a utilização de métodos de localização por imagem como a estereotaxia apresentam várias vantagens como: menor incisão de pele, craniotomia e manipulação do tecido cerebral, consequentemente com menor morbidade. Apresentamos uma série de nove angiomas cavernosos tratados por ressecção cirúrgica radical guiada por estereotaxia. Em todos os casos o diagnóstico foi realizado por ressonância magnética e houve confirmação anátomo-patológica. A média de idade dos pacientes foi 30 anos, variando entre 20 e 54 anos. Como morbidade transitória, um paciente teve uma crise convulsiva no 3° dia pós-operatório e uma paciente apresentou disfasia e hemiparesia no 2° dia pós-operatório, com recuperação total na evolução. No total, a remoção foi radical em todos os casos e os pacientes permanecem sem nenhum déficit neurológico relacionado à cirurgia.Intracerebral cavernous angiomas may cause hemorrhage, epileptic seizures and neurological deficits. The diagnosis of these lesions became easier with the advent of the magnetic resonance image (MRI. Radical resection is the treatment of choice. Due to frequent subcortical or deep location, image-guided techniques, such as stereotactic-guided surgery, offer many advantages as smaller skin incision and craniotomy, less brain manipulation with consequently lower morbidity. We present a series of nine cavernous angiomas treated by stereotactic-guided radical surgical resection. The diagnosis was done by MRI and confirmed by pathologic studies in all cases. Mean age of patients was 30 years old (range 20-54 years. Postoperative morbidity

  16. [Frameless stereotactic biopsy: diagnostic yield and complications].

    Science.gov (United States)

    Castle, Maria; Nájera, Edinson; Samprón, Nicolas; Bollar, Alicia; Urreta, Iratxe; Urculo, Enrique

    2014-01-01

    The aim of this study was to evaluate the variables that could modify the diagnostic yield of frameless stereotactic biopsy, as well as its complications. This was a retrospective study of frameless stereotactic biopsies carried out between July 2008 and December 2011 at Donostia University Hospital. The variables studied were size, distance to the cortex, contrast uptake and location. A total of 70 patients were included (75 biopsies); 39 males and 31 females with an age range between 39 and 83 years. The total diagnostic yield in our series was 97.1%. For lesions >19mm, the technique offered a sensitivity of 95.2% (95% CI: 86.9-98.4) and specificity of 57.1% (95% CI: 25.0-84.2). The yield was lower for lesions within 17mm of the cortex: sensitivity of 74.6% (95% CI: 62.1-84.7) and specificity of 71.4% (95% CI: 29.0-96.3). Seven (10%) patients developed complications after the first biopsy and none after the second. The diagnostic yield was lower for lesions less than 2cm in size and located superficially. In this series we did not observe an increased rate of complications after a second biopsy. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  17. Stereotactic multiple are radiotherapy. IV--Haemangioblastoma.

    Science.gov (United States)

    Chakraborti, P R; Chakrabarti, K B; Doughty, D; Plowman, P N

    1997-04-01

    Our initial experience in the treatment of haemangioblastoma using conventional external beam radiotherapy and stereotactic radiotherapy (radiosurgery), by the linear accelerator method, is reported. Six haemangioblastomas in five patients were treated with a mean follow-up of 40 months (range 14-60). Five haemangioblastomas in four patients were treated with stereotactic radiotherapy, where four showed complete radiological response and the fifth was static. Neurological symptoms and signs improved in those patients. The sixth haemangioblastoma was situated close to the pituitary and optic chiasm, and was treated with conventionally fractionated external beam radiotherapy. The lesion showed partial response. No complications were noted in this patient group. This series complements and extends the relatively sparse published literature demonstrating that radiotherapy is an effective option for treating haemangioblastomas. Radiosurgery often lends itself particularly well to these discrete lesions allowing highly focused treatment. For patients with multiple and metachronous cerebellar haemangioblastomas as part of the von Hipple-Lindau syndrome, the data support a policy of conventionally fractionated external beam radiotherapy to the whole cerebellum of 50-55 Gy followed, after a period of time, by radiosurgery to persisting lesions (patients 3 and 4).

  18. The Technique, Resources and Costs of Stereotactic Body Radiotherapy of Prostate Cancer: A Comparison of Dose Regimens and Delivery Systems.

    Science.gov (United States)

    Sharieff, Waseem; Greenspoon, Jeffrey N; Dayes, Ian; Chow, Tom; Wright, James; Lukka, Himu

    2016-02-01

    Robotic system has been used for stereotactic body radiotherapy (SBRT) of prostate cancer. Arc-based and fixed-gantry systems are used for hypofractionated regimens (10-20 fractions) and the standard regimen (39 fractions); they may also be used to deliver SBRT. Studies are currently underway to compare efficacy and safety of these systems and regimens. Thus, we describe the technique and required resources for the provision of robotic SBRT in relation to the standard regimen and other systems to guide investment decisions. Using administrative data of resource volumes and unit prices, we computed the cost per patient, cost per cure and cost per quality adjusted life year (QALY) of four regimens (5, 12, 20 and 39 fractions) and three delivery systems (robotic, arc-based and fixed-gantry) from a payer's perspective. We performed sensitivity analyses to examine the effects of daily hours of operation and in-room treatment delivery times on cost per patient. In addition, we estimated the budget impact when a robotic system is preferred over an arc-based or fixed-gantry system. Costs of SBRT were $6333/patient (robotic), $4368/patient (arc-based) and $4443/patient (fixed-gantry). When daily hours of operation were varied, the cost of robotic SBRT varied from $9324/patient (2 hours daily) to $5250/patient (10 hours daily). This was comparable to the costs of 39 fraction standard regimen which were $5935/patient (arc-based) and $7992/ patient (fixed-gantry). In settings of moderate to high patient volume, robotic SBRT is cost effective compared to the standard regimen. If SBRT can be delivered with equivalent efficacy and safety, the arc-based system would be the most cost effective system.

  19. Protocol of image guided off-line using cone beam CT megavoltage; Protocolo de imagen guiada off-line mediante Cone Beam CT de megavoltaje

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Ruiz-Zorrilla, J.; Fernandez Leton, J. P.; Perez Moreno, J. M.; Zucca Aparicio, D.; Minambres Moro, A.

    2013-07-01

    The goal of image guided protocols offline is to reduce systematic errors in positioning of the patient in the treatment unit, being more important than the random errors, since the systematic have one contribution in the margin of the CTV to the PTV. This paper proposes a protocol for image guided offline with the different actions to take with their threshold values evaluated previously by anatomic location in a sample of 474 patients and 4821Cone beam Megavoltaje CT (CBCT). (Author)

  20. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study

    DEFF Research Database (Denmark)

    LU, Fokdal; Sturdza, Alina; Mazeron, Renaud

    2016-01-01

    Background and purpose Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC/IS) applicat......Background and purpose Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC...

  1. Robotic transportation.

    Science.gov (United States)

    Lob, W S

    1990-09-01

    Mobile robots perform fetch-and-carry tasks autonomously. An intelligent, sensor-equipped mobile robot does not require dedicated pathways or extensive facility modification. In the hospital, mobile robots can be used to carry specimens, pharmaceuticals, meals, etc. between supply centers, patient areas, and laboratories. The HelpMate (Transitions Research Corp.) mobile robot was developed specifically for hospital environments. To reach a desired destination, Help-Mate navigates with an on-board computer that continuously polls a suite of sensors, matches the sensor data against a pre-programmed map of the environment, and issues drive commands and path corrections. A sender operates the robot with a user-friendly menu that prompts for payload insertion and desired destination(s). Upon arrival at its selected destination, the robot prompts the recipient for a security code or physical key and awaits acknowledgement of payload removal. In the future, the integration of HelpMate with robot manipulators, test equipment, and central institutional information systems will open new applications in more localized areas and should help overcome difficulties in filling transport staff positions.

  2. Cultural Robotics: The Culture of Robotics and Robotics in Culture

    OpenAIRE

    2013-01-01

    In this paper, we have investigated the concept of "Cultural Robotics" with regard to the evolution of social into cultural robots in the 21st Century. By defining the concept of culture, the potential development of a culture between humans and robots is explored. Based on the cultural values of the robotics developers, and the learning ability of current robots, cultural attributes in this regard are in the process of being formed, which would define the new concept of cultural robotics. Ac...

  3. SU-F-P-23: Setup Uncertainties for the Lung Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Q; Vigneri, P; Madu, C; Potters, L [Northwell Health, New Hyde Park, NY (United States); Cao, Y; Jamshidi, A [Northwell Health, Lake Success, NY (United States); Klein, E [Long Island Jewish Medical Center, Lake Success, NY (United States)

    2016-06-15

    Purpose: The Exactrack X-ray system with six degree-of-freedom (6DoF) adjustment ability can be used for setup of lung stereotactic body radiation therapy. The setup uncertainties from ExacTrack 6D system were analyzed. Methods: The Exactrack X-ray 6D image guided radiotherapy system is used in our clinic. The system is an integration of 2 subsystems: (1): an infrared based optical position system and (2) a radiography kV x-ray imaging system. The infrared system monitors reflective body markers on the patient’s skin to assistant in the initial setup. The radiographic kV devices were used for patient positions verification and adjustment. The position verification was made by fusing the radiographs with the digitally reconstructed radiograph (DRR) images generated by simulation CT images using 6DoF fusion algorithms. Those results were recorded in our system. Gaussian functions were used to fit the data. Results: For 37 lung SBRT patients, the image registration results for the initial setup by using surface markers and for the verifications, were measured. The results were analyzed for 143 treatments. The mean values for the lateral, longitudinal, vertical directions were 0.1, 0.3 and 0.3mm, respectively. The standard deviations for the lateral, longitudinal and vertical directions were 0.62, 0.78 and 0.75mm respectively. The mean values for the rotations around lateral, longitudinal and vertical directions were 0.1, 0.2 and 0.4 degrees respectively, with standard deviations of 0.36, 0.34, and 0.42 degrees. Conclusion: The setup uncertainties for the lung SBRT cases by using Exactrack 6D system were analyzed. The standard deviations of the setup errors were within 1mm for all three directions, and the standard deviations for rotations were within 0.5 degree.

  4. Megavoltage conebeam CT cine as final verification of treatment plan in lung stereotactic body radiotherapy.

    Science.gov (United States)

    Kudithipudi, Vijay; Gayou, Olivier; Colonias, Athanasios

    2016-06-01

    To analyse the clinical impact of megavoltage conebeam computed tomography (MV-CBCT) cine on internal target volume (ITV) coverage in lung stereotactic body radiotherapy (SBRT). One hundred and six patients received lung SBRT. All underwent 4D computed tomography simulation followed by treatment via image guided 3D conformal or intensity modulated radiation. Prior to SBRT, all patients underwent MV-CBCT cine, in which raw projections are displayed as beam's-eye-view fluoroscopic series with the planning target volume (PTV) projected onto each image, enabling verification of tumour motion relative to the PTV and assessment of adequacy of treatment margin. Megavoltage conebeam computed tomography cine was completed 1-2 days prior to SBRT. Four patients (3.8%) had insufficient ITV coverage inferiorly at cine review. All four plans were changed by adding 5 mm on the PTV margin inferiorly. The mean change in PTV volumes was 3.9 cubic centimetres (cc) (range 1.85-6.32 cc). Repeat cine was performed after plan modification to ensure adequate PTV coverage in the modified plans. PTV margin was adequate in the majority of patients with this technique. MV-CBCT cine did show insufficient coverage in a small subset of patients. Insufficient PTV margins may be a function of 4D CT simulation inadequacies or deficiencies in visualizing the ITV inferior border in the full-inhale phase. MV-CBCT cine is a valuable tool for final verification of PTV margins. © 2016 The Royal Australian and New Zealand College of Radiologists.

  5. Hypofractionated stereotactic radiotherapy to the rat hippocampus. Determination of dose response and tolerance

    Energy Technology Data Exchange (ETDEWEB)

    Ernst-Stecken, A.; Roedel, F.; Grabenbauer, G.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Radiation Therapy and Novalis Shaped Beam Surgery Center; Jeske, I.; Bluemcke, I. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Neuropathology; Hess, A. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Experimental and Clinical Pharmacology and Toxicology; Ganslandt, O. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Neurosurgery; Brune, K. [Erlangen-Nuernberg Univ., Erlangen (Germany). Doerenkamp Professor for Innovations in Animal and Consumer Protection

    2007-08-15

    Purpose: To determine the effect of hypofractionated stereotactic radiotherapy (hfSRT) on adult rat brain tissue (necrosis, impact on blood-brain barrier, signal changes on high-field magnetic resonance imaging [MRI]). Material and Methods: Adult male Wistar rats underwent MRI and CT scanning of the brain and respective images were introduced into the Novalis trademark radiosurgery device (BrainLab, Feldkirchen, Germany). All animals (body weight 350 g) were irradiated weekly with doses of 2 x 10 Gy (n = 3 animals), 3 x 10 Gy (n = 3 animals) and 4 x 10 Gy (n = 3 animals), targeted to the left hippocampus after image-guided positioning. 4.7-T T2-weighted MRI scanning was performed in each animal. Animals were sacrificed 8, 12, and 16 weeks after hfSRT and brains were immersion-fixed in 4% paraformaldehyde for subsequent histopathologic analysis. Results: In concordance with isodose distributions, pathologic signal hyperintensities in MRI were recorded from 4 x 10 Gy after 8 weeks, 3 x 10 Gy after 12 weeks, while 2 x 10 Gy induced slight detectable alterations only after 16 weeks. Subsequent histopathologic analysis revealed hippocampal cell necrosis with significantly earlier and stronger occurrence for higher doses (40 Gy > 30 Gy > 20 Gy). Pial microvessel permeability also increased after 40 Gy, whereas 30 Gy induced moderate changes. Conclusion: Conclusion: Partial-brain irradiation with hfSRT (Novalis trademark System) was successfully adopted for small animals and histopathologic analysis confirmed its repositioning accuracy. The neuropathologic effects correlated with dose and observation time. The approach will be further developed for quality assurance in hfSRT of normal brain tissue, as well as novel treatment modalities in epileptic rats and orthotopic tumor models. (orig.)

  6. A study to evaluate the efficacy of CBCT and EXACTRAC on spine stereotactic body radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Woo Keun; Park, Su Yeon; Park, Do Keun; Song, Ki Won [Dept. of Radiation Oncology, Samsung Medical Center, Seoul (Korea, Republic of)

    2013-09-15

    This study is to evaluate the efficacy of the CBCT and EXACTRAC the image on the spine stereotactic body radiation treatment. The study compared the accuracy of the dose distribution for changes in the real QA phantom for The shape of the body of the phantom was performed. Novalis treatment artificially set up at the center and to the right, on the Plan 1 mm, 2 mm, 3 mm in front 1 mm, 2 mm, 3 mm and upwards 1 mm, 2 mm, 3 mm and 0.5 degrees by moving side to side Exactrac error correction and error values of CBCT and plan changes on the dose distribution were recorded and analyzed. Cubic Phantom of the experimental error, the error correction Exactrac X-ray 6D Translation in the direction of the 0.18 mm, Rotation direction was 0.07 degrees. Translation in the direction of the 3D CBCT 0.15 mm Rotation direction was 0.04 degrees. DVH dose distribution using the results of the AP evaluate the change in the direction of change was greatest when moving. ExacTrac image-guided radiation therapy with a common easy and fast to get pictures from all angles, from the advantage of CBCT showed a potential alternative. But every accurate information compared with CT treatment planning and treatment of patients with more accurate than the CBCT ExacTrac the location provided. Changes in the dose distribution in the experiment results show that the treatment of spinal SBRT set up some image correction due to errors at the target and enter the spinal cord dose showed that significant differences appear.

  7. Social Robots

    DEFF Research Database (Denmark)

    Social robotics is a cutting edge research area gathering researchers and stakeholders from various disciplines and organizations. The transformational potential that these machines, in the form of, for example, caregiving, entertainment or partner robots, pose to our societies and to us...... as individuals seems to be limited by our technical limitations and phantasy alone. This collection contributes to the field of social robotics by exploring its boundaries from a philosophically informed standpoint. It constructively outlines central potentials and challenges and thereby also provides a stable...

  8. Long-term decision regret after post-prostatectomy image-guided intensity-modulated radiotherapy.

    Science.gov (United States)

    Shakespeare, Thomas P; Chin, Stephen; Manuel, Lucy; Wen, Shelly; Hoffman, Matthew; Wilcox, Shea W; Aherne, Noel J

    2017-02-01

    Decision regret (DR) may occur when a patient believes their outcome would have been better if they had decided differently about their management. Although some studies investigate DR after treatment for localised prostate cancer, none report DR in patients undergoing surgery and post-prostatectomy radiotherapy. We evaluated DR in this group of patients overall, and for specific components of therapy. We surveyed 83 patients, with minimum 5 years follow-up, treated with radical prostatectomy (RP) and post-prostatectomy image-guided intensity-modulated radiotherapy (IG-IMRT) to 64-66 Gy following www.EviQ.org.au protocols. A validated questionnaire identified DR if men either indicated that they would have been better off had they chosen another treatment, or they wished they could change their mind about treatment. There was an 85.5% response rate, with median follow-up post-IMRT 78 months. Adjuvant IG-IMRT was used in 28% of patients, salvage in 72% and ADT in 48%. A total of 70% of patients remained disease-free. Overall, 16.9% of patients expressed DR for treatment, with fourfold more regret for the RP component of treatment compared to radiotherapy (16.9% vs 4.2%, P = 0.01). DR for androgen deprivation was 14.3%. Patients were regretful of surgery due to toxicity, not being adequately informed about radiotherapy as an alternative, positive margins and surgery costs (83%, 33%, 25% and 8% of regretful patients respectively). Toxicity caused DR in the three radiotherapy-regretful and four ADT-regretful patients. Patients were twice as regretful overall, and of surgery, for salvage vs adjuvant approaches (both 19.6% vs 10.0%). Decision regret after RP and post-prostatectomy IG-IMRT is uncommon, although patients regret RP more than post-operative IG-IMRT. This should reassure urologists referring patients for post-prostatectomy IG-IMRT, particularly in the immediate adjuvant setting. Other implications include appropriate patient selection for RP (and

  9. Acute toxicity in prostate cancer patients treated with and without image-guided radiotherapy

    Directory of Open Access Journals (Sweden)

    Williams Scott

    2011-10-01

    Full Text Available Abstract Background Image-guided radiotherapy (IGRT increases the accuracy of treatment delivery through daily target localisation. We report on toxicity symptoms experienced during radiotherapy treatment, with and without IGRT in prostate cancer patients treated radically. Methods Between 2006 and 2009, acute toxicity data for ten symptoms were collected prospectively onto standardized assessment forms. Toxicity was scored during radiotherapy, according to the Common Terminology Criteria Adverse Events V3.0, for 275 prostate cancer patients before and after the implementation of a fiducial marker IGRT program and dose escalation from 74Gy in 37 fractions, to 78Gy in 39 fractions. Margins and planning constraints were maintained the same during the study period. The symptoms scored were urinary frequency, cystitis, bladder spasm, urinary incontinence, urinary retention, diarrhoea, haemorrhoids, proctitis, anal skin discomfort and fatigue. Analysis was conducted for the maximum grade of toxicity and the median number of days from the onset of that toxicity to the end of treatment. Results In the IGRT group, 14228 toxicity scores were analysed from 249 patients. In the non-IGRT group, 1893 toxicity scores were analysed from 26 patients. Urinary frequency ≥G3 affected 23% and 7% in the non-IGRT and IGRT group respectively (p = 0.0188. Diarrhoea ≥G2 affected 15% and 3% of patients in the non-IGRT and IGRT groups (p = 0.0174. Fatigue ≥G2 affected 23% and 8% of patients in the non-IGRT and IGRT groups (p = 0.0271. The median number of days with a toxicity was higher for ≥G2 (p = 0.0179 and ≥G3 frequency (p = 0.0027, ≥G2 diarrhoea (p = 0.0033 and ≥G2 fatigue (p = 0.0088 in the non-IGRT group compared to the IGRT group. Other toxicities were not of significant statistical difference. Conclusions In this study, prostate cancer patients treated radically with IGRT had less severe urinary frequency, diarrhoea and fatigue during treatment

  10. Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Poetter, Richard; Kirisits, Christian; Fidarova, Elena F.; Dimopoulos, Johannes C. A.; Berger, Daniel; Tanderup, Kari; Lindegaard, Jacob C. (Dept. of Radiotherapy Medical Univ. of Vienna, General Hospital Vienna, Wien (Austria))

    2008-08-15

    Introduction. Image guided adaptive brachytherapy (IGABT) for cervical cancer, using mainly MRI, is an evolving method, increasingly replacing the 2D approach based on conventional radiography. During the complex 4D chain of this procedure image-assistance is provided for disease assessment, provisional treatment planning ('pre-planning'), applicator placement and reconstruction, as well as for contouring, definitive treatment planning and quality control of dose delivery. With IGABT changes of topography adjacent to the applicator, caused by tumour regression, oedema, organ changes and dilation are identified. Thus, the CTV for IGABT is primarily based on the tumour volume at the time of BT and takes into account both time and spatial domains. IGABT requires systematic concepts for target, OAR, biological modelling, DVH analysis, and dose-volume-adaptation. Methods and Results. This report focuses on the advantages and uncertainties, dose-effect relations and clinical results of the IGABT procedure addressing the current status and future perspectives. Uncertainties during the 4D chain of IGABT are mainly related to target contouring, applicator reconstruction, as well as to inter-fraction, intra-fraction and inter-application variability, as caused by tumour response and organ changes. Different from EBRT where set-up uncertainties are compensated by adding a margin to the CTV, no margins to the lateral and anterior-posterior directions can be used for IGABT. Discussion. By 3D treatment planning for IGABT significant improvement of the DVH parameters is achieved compared to 2D library plans. In small tumours the benefit is primarily obtained by a decrease of dose to nearby OAR while in large tumours the use of supplementary interstitial techniques and optimization may double the target volume that can be treated at a therapeutic dose level. The clinical impact of IGABT could recently be demonstrated by the establishment of some correlations between

  11. Dosimetric consequences of translational and rotational errors in frame-less image-guided radiosurgery

    Directory of Open Access Journals (Sweden)

    Guckenberger Matthias

    2012-04-01

    Full Text Available Abstract Background To investigate geometric and dosimetric accuracy of frame-less image-guided radiosurgery (IG-RS for brain metastases. Methods and materials Single fraction IG-RS was practiced in 72 patients with 98 brain metastases. Patient positioning and immobilization used either double- (n = 71 or single-layer (n = 27 thermoplastic masks. Pre-treatment set-up errors (n = 98 were evaluated with cone-beam CT (CBCT based image-guidance (IG and were corrected in six degrees of freedom without an action level. CBCT imaging after treatment measured intra-fractional errors (n = 64. Pre- and post-treatment errors were simulated in the treatment planning system and target coverage and dose conformity were evaluated. Three scenarios of 0 mm, 1 mm and 2 mm GTV-to-PTV (gross tumor volume, planning target volume safety margins (SM were simulated. Results Errors prior to IG were 3.9 mm ± 1.7 mm (3D vector and the maximum rotational error was 1.7° ± 0.8° on average. The post-treatment 3D error was 0.9 mm ± 0.6 mm. No differences between double- and single-layer masks were observed. Intra-fractional errors were significantly correlated with the total treatment time with 0.7mm±0.5mm and 1.2mm±0.7mm for treatment times ≤23 minutes and >23 minutes (p5% in 14% of the patients. A 1 mm safety margin fully compensated intra-fractional patient motion. Conclusions IG-RS with online correction of translational errors achieves high geometric and dosimetric accuracy. Intra-fractional errors decrease target coverage and conformity unless compensated with appropriate safety margins.

  12. Image-guided adaptive radiotherapy for prostate and head-and-neck cancers

    Science.gov (United States)

    O'Daniel, Jennifer C.

    In the current practice of radiation therapy, daily patient alignments have been based on external skin marks or on bone. However, internal organ variation (both motion and volumetric changes) between treatment fractions can displace the treatment target, causing target underdosage and normal tissue overdosage. In order to deliver the radiation treatment as planned, more accurate knowledge of the daily internal anatomy was needed. Additionally, treatments needed to adapt to these variations by either shifting the patient to account for the daily target position or by altering the treatment plan. In this dissertation, the question of whether inter-fractional variations in internal patient anatomy combined with external set-up uncertainties produced measurable differences between planned and delivered doses for prostate and head-and-neck cancer patients was investigated. Image-guided adaptive treatment strategies to improve tumor coverage and/or reduce normal tissue dose were examined. Treatment deliveries utilizing various alignment procedures for ten prostate cancer patients and eleven head-and-neck cancer patients, each of whom received multiple CT scans over the course of treatment, were simulated. The largest prostate dose losses between planning and delivery were correlated with anterior/posterior and superior/inferior prostate displacement. Daily bone alignment sufficiently maintained target coverage for 70% of patients, ultrasound for 90%, and CT for 100%. A no-action-level correction protocol, which corrected the daily bone alignment for the systematic internal displacement of the prostate based on a pre-determined number of CT image sets, successfully improved the prostate and seminal vesicle dosimetric coverage. Three CT image sets were sufficient to accurately correct the bone alignment scheme for the prostate internal systematic shifts. For head-and-neck cancer patient treatment, setup uncertainties and internal organ variations did not greatly affect

  13. Radioterapia guiada por imagen: Impacto clínico Clinical impact of image guided radiotherapy

    Directory of Open Access Journals (Sweden)

    P. Romero

    2009-01-01

    Full Text Available La radioterapia guiada por imagen (RTGI es un concepto que engloba la manera más moderna de administrar el tratamiento radioterápico El objetivo es maximizar la dosis depositada en el volumen a tratar (target, minimizando la dosis en los órganos sanos. Esto no sería posible sin el continuo desarrollo tecnológico y de los software, sobre todo en las siguientes áreas: registrar imágenes deformables, replanificar nuevos tratamientos, imagen en tiempo real y cálculo de dosis acumulada. El impacto clínico es evidente, pero poco se habla del impacto en la reorganización de los servicios de Oncología Radioterápica. La RTGI supone un entrenamiento de todo el equipo involucrado, con un periodo de aprendizaje y puesta en marcha. Con la experiencia adquirida, el tiempo dedicado a cada paciente (en todas las etapas de su tratamiento: simulación, planificación, puesta en marcha, sistemas de verificación de posicionamiento, correcciones on-line, off-line, replanificación, controles clínicos periódicos, es muy superior al que se precisa en la radioterapia convencional, motivo por el que aparecen nuevas responsabilidades y roles.Image guided radiotherapy (IGR is a concept that encompasses the most modern way of administering radiotherapy treatment. The aim is to maximise the dose deposited in the target volume, minimising the dose in healthy organs. This would not be possible without the continuous development of technology and software, above all in the following areas: deformable image registration, replanning new treatments, real time image and calculation of accumulated dose. While the clinical impact is evident, little is said about the impact on the reorganisation of the Radiotherapy Oncology services. IGR supposes training all team members involved, with a training and a starting period. With the experience acquired, the time dedicated to each patient (in all stages of treatment: simulation, planning, starting out, systems for verifying

  14. Comparing the Zeiss Callisto Eye and the Alcon Verion Image Guided System Toric Lens Alignment Technologies.

    Science.gov (United States)

    Hura, Arjan S; Osher, Robert H

    2017-07-01

    To compare the alignment meridian generated by the Zeiss Callisto Eye (Carl Zeiss AG, Dublin, CA) and the Alcon Verion Image Guided System (Alcon Laboratories, Inc., Fort Worth, TX). In this retrospective comparative evaluation of technology, intraoperative images were captured at different steps in the same surgery, allowing the comparison of the guidance lines generated by the Verion system to the parallel guidance lines generated by the Callisto Eye system. Measurements of each hemi-meridian were quantified using Adobe Photoshop 2015 CC software (Adobe Systems, San Jose, CA). The numbers of degrees separating these alignment meridians were calculated, entered into a database, and analyzed. The authors found that of 98 captured images of 16 eyes, the two technologies were identical in 0 eyes (θ1 = θ2 = 0), similar by 3° in 52 (53%) captured images (θ1 ≠ θ2 ≠ 0), and different by at least 3° in 46 (47%) captured images (θ1 ≠ θ2 ≠ 0). The target meridians were superimposed, the target lines were minimally separated, and the target lines were dissimilar. It was noted that some intraoperative variation occurred from measurement to measurement. Within the small group of 16 cases of routine toric lens implantation in this study, the absolute average number of degrees of misalignment between the Verion and Callisto Eye systems was 3.355 for θ1 and 3.838 for θ2. On average, the intraoperative variation termed "drift" was noted to be 3.963° for θ1, and 4.557° for θ2. The authors found that small deviations were frequent when comparing two sophisticated technologies. Although deviations greater than 3° occurred in less than 47% of captured images from 16 eyes, smaller but significant variations of less than 3° occurred in 53% of captured images from 16 eyes. It was rare to identify a large deviation. However, the authors identified "drift" in the same eye when measurements were taken at different times. The results indicate that the two systems are

  15. C-arm positioning using virtual fluoroscopy for image-guided surgery

    Science.gov (United States)

    de Silva, T.; Punnoose, J.; Uneri, A.; Goerres, J.; Jacobson, M.; Ketcha, M. D.; Manbachi, A.; Vogt, S.; Kleinszig, G.; Khanna, A. J.; Wolinsky, J.-P.; Osgood, G.; Siewerdsen, J. H.

    2017-03-01

    Introduction: Fluoroscopically guided procedures often involve repeated acquisitions for C-arm positioning at the cost of radiation exposure and time in the operating room. A virtual fluoroscopy system is reported with the potential of reducing dose and time spent in C-arm positioning, utilizing three key advances: robust 3D-2D registration to a preoperative CT; real-time forward projection on GPU; and a motorized mobile C-arm with encoder feedback on C-arm orientation. Method: Geometric calibration of the C-arm was performed offline in two rotational directions (orbit α, orbit β). Patient registration was performed using image-based 3D-2D registration with an initially acquired radiograph of the patient. This approach for patient registration eliminated the requirement for external tracking devices inside the operating room, allowing virtual fluoroscopy using commonly available systems in fluoroscopically guided procedures within standard surgical workflow. Geometric accuracy was evaluated in terms of projection distance error (PDE) in anatomical fiducials. A pilot study was conducted to evaluate the utility of virtual fluoroscopy to aid C-arm positioning in image guided surgery, assessing potential improvements in time, dose, and agreement between the virtual and desired view. Results: The overall geometric accuracy of DRRs in comparison to the actual radiographs at various C-arm positions was PDE (mean ± std) = 1.6 ± 1.1 mm. The conventional approach required on average 8.0 ± 4.5 radiographs spent "fluoro hunting" to obtain the desired view. Positioning accuracy improved from 2.6o ± 2.3o (in α) and 4.1o ± 5.1o (in β) in the conventional approach to 1.5o ± 1.3o and 1.8o ± 1.7o, respectively, with the virtual fluoroscopy approach. Conclusion: Virtual fluoroscopy could improve accuracy of C-arm positioning and save time and radiation dose in the operating room. Such a system could be valuable to training of fluoroscopy technicians as well as

  16. Temporal regularization of ultrasound-based liver motion estimation for image-guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    O’Shea, Tuathan P., E-mail: tuathan.oshea@icr.ac.uk; Bamber, Jeffrey C.; Harris, Emma J. [Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS foundation Trust, Sutton, London SM2 5PT (United Kingdom)

    2016-01-15

    Purpose: Ultrasound-based motion estimation is an expanding subfield of image-guided radiation therapy. Although ultrasound can detect tissue motion that is a fraction of a millimeter, its accuracy is variable. For controlling linear accelerator tracking and gating, ultrasound motion estimates must remain highly accurate throughout the imaging sequence. This study presents a temporal regularization method for correlation-based template matching which aims to improve the accuracy of motion estimates. Methods: Liver ultrasound sequences (15–23 Hz imaging rate, 2.5–5.5 min length) from ten healthy volunteers under free breathing were used. Anatomical features (blood vessels) in each sequence were manually annotated for comparison with normalized cross-correlation based template matching. Five sequences from a Siemens Acuson™ scanner were used for algorithm development (training set). Results from incremental tracking (IT) were compared with a temporal regularization method, which included a highly specific similarity metric and state observer, known as the α–β filter/similarity threshold (ABST). A further five sequences from an Elekta Clarity™ system were used for validation, without alteration of the tracking algorithm (validation set). Results: Overall, the ABST method produced marked improvements in vessel tracking accuracy. For the training set, the mean and 95th percentile (95%) errors (defined as the difference from manual annotations) were 1.6 and 1.4 mm, respectively (compared to 6.2 and 9.1 mm, respectively, for IT). For each sequence, the use of the state observer leads to improvement in the 95% error. For the validation set, the mean and 95% errors for the ABST method were 0.8 and 1.5 mm, respectively. Conclusions: Ultrasound-based motion estimation has potential to monitor liver translation over long time periods with high accuracy. Nonrigid motion (strain) and the quality of the ultrasound data are likely to have an impact on tracking

  17. Multi-institutional dosimetric and geometric commissioning of image-guided small animal irradiators

    Energy Technology Data Exchange (ETDEWEB)

    Lindsay, P. E., E-mail: Patricia.Lindsay@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 1A1 (Canada); Granton, P. V.; Hoof, S. van; Hermans, J. [Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6201 BN (Netherlands); Gasparini, A. [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Jelveh, S. [Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Clarkson, R. [Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 1A1 (Canada); Mid-South Radiation Physics, Inc., 1801 South 54th Street, Paragould, Arkansas 72450 (United States); Kaas, J.; Wittkamper, F.; Sonke, J.-J. [Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Verhaegen, F. [Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6201 BN (Netherlands); Medical Physics Unit, Department of Oncology, McGill University, Montreal, Québec H3G 1A4 (Canada); Jaffray, D. A. [Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 1A1 (Canada); The TECHNA Institute for the Advancement of Technology for Health, Toronto, Ontario M5G 1P5 (Canada)

    2014-03-15

    Purpose: To compare the dosimetric and geometric properties of a commercial x-ray based image-guided small animal irradiation system, installed at three institutions and to establish a complete and broadly accessible commissioning procedure. Methods: The system consists of a 225 kVp x-ray tube with fixed field size collimators ranging from 1 to 44 mm equivalent diameter. The x-ray tube is mounted opposite a flat-panel imaging detector, on a C-arm gantry with 360° coplanar rotation. Each institution performed a full commissioning of their system, including half-value layer, absolute dosimetry, relative dosimetry (profiles, percent depth dose, and relative output factors), and characterization of the system geometry and mechanical flex of the x-ray tube and detector. Dosimetric measurements were made using Farmer-type ionization chambers, small volume air and liquid ionization chambers, and radiochromic film. The results between the three institutions were compared. Results: At 225 kVp, with 0.3 mm Cu added filtration, the first half value layer ranged from 0.9 to 1.0 mm Cu. The dose-rate in-air for a 40 × 40 mm{sup 2} field size, at a source-to-axis distance of 30 cm, ranged from 3.5 to 3.9 Gy/min between the three institutions. For field sizes between 2.5 mm diameter and 40 × 40 mm{sup 2}, the differences between percent depth dose curves up to depths of 3.5 cm were between 1% and 4% on average, with the maximum difference being 7%. The profiles agreed very well for fields >5 mm diameter. The relative output factors differed by up to 6% for fields larger than 10 mm diameter, but differed by up to 49% for fields ≤5 mm diameter. The mechanical characteristics of the system (source-to-axis and source-to-detector distances) were consistent between all three institutions. There were substantial differences in the flex of each system. Conclusions: With the exception of the half-value layer, and mechanical properties, there were significant differences between the

  18. Calibration of three-dimensional ultrasound images for image-guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Bouchet, Lionel G. [Department of Neurological Surgery, University of Florida, Gainesville, FL (United States). E-mail: bouchet at neurosurgery.ufl.edu; Bova, Francis J.; Friedman, William A. [Department of Neurological Surgery, University of Florida, Gainesville, FL (United States); Meeks, Sanford L.; Buatti, John M. [Division of Radiation Oncology, University of Iowa, Iowa City, IA (United States); Goodchild, Gordon [Medtronic Surgical Navigation Technologies, Broomfield, CO (United States)

    2001-02-01

    overall tracking accuracy of our 3D ultrasound image-guided positioning system was measured to be on average 0.2 mm, 0.9 mm and 0.6 mm for the AP, lateral and axial directions respectively. (author)

  19. Surface-based registration accuracy of CT-based image-guided spine surgery.

    Science.gov (United States)

    Tamura, Yuichi; Sugano, Nobuhiko; Sasama, Toshihiko; Sato, Yoshinobu; Tamura, Shinichi; Yonenobu, Kazuo; Yoshikawa, Hideki; Ochi, Takahiro

    2005-04-01

    Registration is a critical and important process in maintaining the accuracy of CT-based image-guided surgery. The aim of this study was to evaluate the effects of the area of intraoperative data sampling and number of sampling points on the accuracy of surface-based registration in a CT-based spinal-navigation system, using an optical three-dimensional localizer. A cadaveric dry-bone phantom of the lumbar spine was used. To evaluate registration accuracy, three alumina ceramic balls were attached to the anterior and lateral aspects of the vertebral body. CT images of the phantom were obtained (1-mm slice thickness, at1-mm intervals) using a helical CT scanner. Twenty surface points were digitized from five zones defined on the basis of anatomical classification on the posterior aspects of the target vertebra. A total of 20 sets of sampling data were obtained. Evaluation of registration accuracy accounted for positional and rotational errors. Of the five zones, the area that was the largest and easiest to expose surgically and to digitize surface points was the lamina. The lamina was defined as standard zone. On this zone, the effect of the number of sampling points on the positional and rotational accuracy of registration was evaluated. And the effects of the additional area selected for intraoperative data sampling on the registration accuracy were evaluated. Using 20 surface points on the posterior side of the lamina, positional error was 0.96 mm +/- 0.24 mm root-mean-square (RMS) and rotational error was 0.91 degrees +/- 0.38 degrees RMS. The use of 20 surface points on the lamina usually allows surgeons to carry out sufficiently accurate registration to conduct computer-aided spine surgery. In the case of severe spondylosis, however, it might be difficult to digitize the surface points from the lamina, due to a hypertrophic facet joint or the deformity of the lamina and noisy sampling data. In such cases, registration accuracy can be improved by combining use

  20. Stereotactic Body Radiotherapy and Ablative Therapies for Lung Cancer.

    Science.gov (United States)

    Abbas, Ghulam; Danish, Adnan; Krasna, Mark J

    2016-07-01

    The treatment paradigm for early stage lung cancer and oligometastatic disease to the lung is rapidly changing. Ablative therapies, especially stereotactic body radiation therapy, are challenging the surgical gold standard and have the potential to be the standard for operable patients with early stage lung cancer who are high risk due to co- morbidities. The most commonly used ablative modalities include stereotactic body radiation therapy, microwave ablation, and radiofrequency ablation.

  1. Light Robotics

    DEFF Research Database (Denmark)

    Glückstad, Jesper; Palima, Darwin

    Light Robotics - Structure-Mediated Nanobiophotonics covers the latest means of sculpting of both light and matter for achieving bioprobing and manipulation at the smallest scales. The synergy between photonics, nanotechnology and biotechnology spans the rapidly growing field of nanobiophotonics...

  2. Cognitive Robotics

    OpenAIRE

    Levesque, Hector J.; Lakemeyer, Gerhard

    2010-01-01

    This chapter is dedicated to the memory of Ray Reiter. It is also an overview of cognitive robotics, as we understand it to have been envisaged by him.1 Of course, nobody can control the use of a term or the direction of research. We apologize in advance to those who feel that other approaches to cognitive robotics and related problems are inadequately represented here.

  3. Robot Rescue

    Science.gov (United States)

    Morring, Frank, Jr.

    2004-01-01

    Tests with robots and the high-fidelity Hubble Space Telescope mockup astronauts use to train for servicing missions have convinced NASA managers it may be possible to maintain and upgrade the orbiting observatory without sending a space shuttle to do the job. In a formal request last week, the agency gave bidders until July 16 to sub-mit proposals for a robotic mission to the space telescope before the end of 2007. At a minimum, the mission would attach a rocket motor to deorbit the telescope safely when its service life ends. In the best case, it would use state-of-the- art robotics to prolong its life on orbit and install new instruments. With the space shuttle off-limits for the job under strict post-Columbia safety policies set by Administrator Sean O'Keefe, NASA has designed a "straw- man" robotic mission that would use an Atlas V or Delta N to launch a 20,ooO-lb. "Hubble Robotic Vehicle" to service the telescope. There, a robotic arm would grapple it, much as the shuttle does.

  4. [Robotic surgery].

    Science.gov (United States)

    Moreno-Portillo, Mucio; Valenzuela-Salazar, Carlos; Quiroz-Guadarrama, César David; Pachecho-Gahbler, Carlos; Rojano-Rodríguez, Martín

    2014-12-01

    Medicine has experienced greater scientific and technological advances in the last 50 years than in the rest of human history. The article describes relevant events, revises concepts and advantages and clinical applications, summarizes published clinical results, and presents some personal reflections without giving dogmatic conclusions about robotic surgery. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) defines robotic surgery as a surgical procedure using technology to aid the interaction between surgeon and patient. The objective of the surgical robot is to correct human deficiencies and improve surgical skills. The capacity of repeating tasks with precision and reproducibility has been the base of the robot´s success. Robotic technology offers objective and measurable advantages: - Improving maneuverability and physical capacity during surgery. - Correcting bad postural habits and tremor. - Allowing depth perception (3D images). - Magnifying strength and movement limits. - Offering a platform for sensors, cameras, and instruments. Endoscopic surgery transformed conceptually the way of practicing surgery. Nevertheless in the last decade, robotic assisted surgery has become the next paradigm of our era.

  5. A cognitive engineering framework for the specification of information requirements in medical imaging: application in image-guided neurosurgery.

    Science.gov (United States)

    Morineau, T; Morandi, X; Le Moëllic, N; Jannin, P

    2013-03-01

    This study proposes a framework coming from cognitive engineering, which makes it possible to define what information content has to be displayed or emphasised from medical imaging, for assisting clinicians according to their level of expertise in the domain. We designed a rating scale to assess visualisation systems in image-guided neurosurgery with respect to the depiction of the neurosurgical work domain. This rating scale was based on a neurosurgical work domain analysis. This scale has been used to evaluate visualisation modes among neurosurgeons, residents and engineers. We asked five neurosurgeons, ten medical residents and ten engineers to rate two visualisation modes from the same data (2D MR image vs. 3D computerised image). With this method, the amount of abstract and concrete work domain information displayed by each visualisation mode can be measured. A global difference in quantities of perceived information between both images was observed. Surgeons and medical residents perceived significantly more information than engineers for both images. Unlike surgeons, however, the amount of information perceived by residents and engineers significantly decreased as information abstraction increased. We demonstrated the possibility of measuring the amount of work domain information displayed by different visualisation modes of medical imaging according to different user profiles. Engineers in charge of the design of medical image-guided surgical systems did not perceive the same set of information as surgeons or even medical residents. This framework can constitute a user-oriented approach to evaluate the amount of perceived information from image-guided surgical systems and support their design from a cognitive engineering point of view.

  6. Implementation of Remote 3-Dimensional Image Guided Radiation Therapy Quality Assurance for Radiation Therapy Oncology Group Clinical Trials

    Energy Technology Data Exchange (ETDEWEB)

    Cui Yunfeng [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Galvin, James M. [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, Pennsylvania (United States); Parker, William [Department of Medical Physics, McGill University Health Center, Montreal, QC (Canada); Breen, Stephen [Department of Radiation Physics, Princess Margaret Hospital, Toronto, ON (Canada); Yin Fangfang; Cai Jing [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Papiez, Lech S. [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Bednarz, Greg [Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Chen Wenzhou [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Xiao Ying, E-mail: ying.xiao@jefferson.edu [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Radiation Therapy Oncology Group, American College of Radiology, Philadelphia, Pennsylvania (United States)

    2013-01-01

    Purpose: To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Methods and Materials: Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. Results: The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. Conclusion: This first experience indicated that remote review for 3D IGRT as part of QA

  7. Implementation of remote 3-dimensional image guided radiation therapy quality assurance for radiation therapy oncology group clinical trials.

    Science.gov (United States)

    Cui, Yunfeng; Galvin, James M; Parker, William; Breen, Stephen; Yin, Fang-Fang; Cai, Jing; Papiez, Lech S; Li, X Allen; Bednarz, Greg; Chen, Wenzhou; Xiao, Ying

    2013-01-01

    To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. This first experience indicated that remote review for 3D IGRT as part of QA for RTOG clinical trials is feasible and effective

  8. Sacro-Iliac Joint Sensory Block and Radiofrequency Ablation: Assessment of Bony Landmarks Relevant for Image-Guided Procedures

    Science.gov (United States)

    Roberts, Shannon L.; Burnham, Robert S.; Loh, Eldon; Agur, Anne M.

    2016-01-01

    Image-guided sensory block and radiofrequency ablation of the nerves innervating the sacro-iliac joint require readily identifiable bony landmarks for accurate needle/electrode placement. Understanding the relative locations of the transverse sacral tubercles along the lateral sacral crest is important for ultrasound guidance, as they demarcate the position of the posterior sacral network (S1–S3 ± L5/S4) innervating the posterior sacro-iliac joint. No studies were found that investigated the spatial relationships of these bony landmarks. The purpose of this study was to visualize and quantify the interrelationships of the transverse sacral tubercles and posterior sacral foramina to inform image-guided block and radiofrequency ablation of the sacro-iliac joint. The posterior and lateral surfaces of 30 dry sacra (15 M/15 F) were digitized and modeled in 3D and the distances between bony landmarks quantified. The relationships of bony landmarks (S1–S4) were not uniform. The mean intertubercular and interforaminal distances decreased from S1 to S4, whereas the distance from the lateral margin of the posterior sacral foramina to the transverse sacral tubercles increased from S1 to S3. The mean intertubercular distance from S1 to S3 was significantly (p < 0.05) larger in males. The interrelationships of the sacral bony landmarks should be taken into consideration when estimating the site and length of an image-guided strip lesion targeting the posterior sacral network. PMID:27747222

  9. SU-E-J-244: Validation of a 6D-Robotic-Couch and Image Guidance Radiation Therapy (IGRT) System for Localization in World's First Single-Room Proton Therapy System

    Energy Technology Data Exchange (ETDEWEB)

    Rankine, L; Klein, E [Washington University, Saint Louis, MO (United States); Grantham, K [University of Missouri, Columbia, MO (United States); Goddu, S [Washington University, St. Louis, MO (United States); Cessac, R [Mevion Medical Systems, Littleton, MA (United States); Baker, K [Barne-Jewish Hospital, St. Louis, MO (United States); Santanam, L [Washington University School of Medicine, St.louis, MO (United States)

    2014-06-01

    Purpose: The Mevion S250 proton therapy unit is equipped with a 6D-robotic couch and IGRT system (Verity). The patient alignment process allows corrections in six degrees of freedom: translation (x,y,z), pitch, roll, and yaw (θ,ϑ,ψ). Geometric accuracy of couch corrections and imaging vs. radiation isocenter coincidence were quantified before clinical implementation. Methods: A commercial phantom with sixteen 2mm tungsten BBs was rigidly couch-mounted and imaged with CT. Seventeen rigid translations/rotations of known magnitude were digitally applied to the original CT image using commercial software, validated with Varian OBI system. For each altered image, phantom was mounted on robotic couch in original position, then Verity 2D:2D match (PA-LLAT) was performed using DRRs from altered images. Corrections were recorded and applied, phantom was imaged a second time and residual corrections recorded. Physical measurements verified that applied couch corrections coincided with both physical couch shifts/rotations and known CT image translations/rotations. Additionally, image vs. radiation isocenter coicidence was quantified over couch treatment angles (±90° from setup position) using radiochromic film and an image-guided couch star-shot. Posterior-anterior and left-lateral kV radiographs were taken before each beam was delivered to verify imaging/radiation isocentricity. Results: Verity suggested couch corrections and known CT shifts/rotations agreed within ±1mm (average: Δ lat=0.5mm; Δ vert=0.4mm; Δ long=0.3mm) and ± 0.4° (average: Δ pitch=0.24° Δ roll=0.01°; Δ yaw=0.10°). Physical couch measurements and Verity applied corrections agreed within ± 1mm (average: Δlat=0.5mm; Δvert=0.4mm; Δlong=0.2mm) and ±0.2° (average: Δpitch=0.03°; Δ roll=0.04°; Δ yaw=0.04°). The directionality of all translations and rotations were qualitatively verified. The image vs. radiation isocenter coincidence was <1mm and radiation-isocenter precision was <1mm

  10. Evaluation of volume change in rectum and bladder during application of image-guided radiotherapy for prostate carcinoma

    Science.gov (United States)

    Luna, J. A.; Rojas, J. I.

    2016-07-01

    All prostate cancer patients from Centro Médico Radioterapia Siglo XXI receive Volumetric Modulated Arc Therapy (VMAT). This therapy uses image-guided radiotherapy (IGRT) with the Cone Beam Computed Tomography (CBCT). This study compares the planned dose in the reference CT image against the delivered dose recalculate in the CBCT image. The purpose of this study is to evaluate the anatomic changes and related dosimetric effect based on weekly CBCT directly for patients with prostate cancer undergoing volumetric modulated arc therapy (VMAT) treatment. The collected data were analyzed using one-way ANOVA.

  11. Photothermal Therapy: Metabolizable Ultrathin Bi2 Se3 Nanosheets in Imaging-Guided Photothermal Therapy (Small 30/2016).

    Science.gov (United States)

    Xie, Hanhan; Li, Zhibin; Sun, Zhengbo; Shao, Jundong; Yu, Xue-Feng; Guo, Zhinan; Wang, Jiahong; Xiao, Quanlan; Wang, Huaiyu; Wang, Qu-Quan; Zhang, Han; Chu, Paul K

    2016-08-01

    Ultrathin Bi2 Se3 nanosheets are prepared by a solution method. As described on page 4136 by X.-F. Yu, Q.-Q. Wang, P. K. Chu, and co-workers, such ultrathin Bi2 Se3 nanosheets exhibit strong near infrared (NIR) light absorption, excellent photothermal and photoacoustic performance, enabling efficient imaging-guided photothermal therapy. Furthermore, these Bi2 Se3 nanosheets are well metabolized. These attractive properties render the Bi2 Se3 nanosheets promising as a NIR-triggered theranostic agents in cancer therapies.

  12. Evaluation of volume change in rectum and bladder during application of image-guided radiotherapy for prostate carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Luna, J. A., E-mail: yosimoon13@hotmail.com [Departamento de Física, Universidad Nacional de Costa Rica, Heredia (Costa Rica); Rojas, J. I., E-mail: isaac.rojas@siglo21.cr [Centro Médico Radioterapia Siglo XX1, La Uruca (Costa Rica); PROXTRONICS CR, Ltda, Heredia (Costa Rica)

    2016-07-07

    All prostate cancer patients from Centro Médico Radioterapia Siglo XXI receive Volumetric Modulated Arc Therapy (VMAT). This therapy uses image-guided radiotherapy (IGRT) with the Cone Beam Computed Tomography (CBCT). This study compares the planned dose in the reference CT image against the delivered dose recalculate in the CBCT image. The purpose of this study is to evaluate the anatomic changes and related dosimetric effect based on weekly CBCT directly for patients with prostate cancer undergoing volumetric modulated arc therapy (VMAT) treatment. The collected data were analyzed using one-way ANOVA.

  13. The current status of robot-assisted radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Prokar Dasgupta; Roger S.Kirby

    2009-01-01

    Robot-assisted radical prostatectomy (RARP) is a rapidly evolving technique for the treatment of localized prostate cancer.In the United States,over 65% of radical prostatectomies are robot-assisted,although the acceptance of this technology in Europe and the rest of the world has been somewhat slower.This article reviews the current literature on RARP with regard to oncological,continence and potency outcomes-the so-called 'trifecta'.Preliminary data appear to show an advantage of RARP over open prostatectomy,with reduced blood loss,decreased pain,early mobilization,shorter hospital stay and lower margin rates.Most studies show good postoperative continence and potency with RARP;however,this needs to be viewed in the context of the paucity of randomized data available in the literature.There is no definitive evidence to show an advantage over standard laparoscopy,but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging.Finally,evolving techniques of single-port robotic prostatectomy,laserguided robotics,catheter-free prostatectomy and image-guided robotics are discussed.

  14. Evaluation of image guided motion management methods in lung cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Ling [Department of Radiation Oncology, Wayne State University School of Medicine, 4100 John R, Detroit, Michigan 48201 (United States); Yan, Di; Liang, Jian; Ionascu, Dan; Mangona, Victor; Yang, Kai; Zhou, Jun, E-mail: jun.zhou@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, Michigan 48073 (United States)

    2014-03-15

    Purpose: To evaluate the accuracy and reliability of three target localization methods for image guided motion management in lung cancer radiotherapy. Methods: Three online image localization methods, including (1) 2D method based on 2D cone beam (CB) projection images, (2) 3D method using 3D cone beam CT (CBCT) imaging, and (3) 4D method using 4D CBCT imaging, have been evaluated using a moving phantom controlled by (a) 1D theoretical breathing motion curves and (b) 3D target motion patterns obtained from daily treatment of 3 lung cancer patients. While all methods are able to provide target mean position (MP), the 2D and 4D methods can also provide target motion standard deviation (SD) and excursion (EX). For each method, the detected MP/SD/EX values are compared to the analytically calculated actual values to calculate the errors. The MP errors are compared among three methods and the SD/EX errors are compared between the 2D and 4D methods. In the theoretical motion study (a), the dependency of MP/SD/EX error on EX is investigated with EX varying from 2.0 cm to 3.0 cm with an increment step of 0.2 cm. In the patient motion study (b), the dependency of MP error on target sizes (2.0 cm and 3.0 cm), motion patterns (four motions per patient) and EX variations is investigated using multivariant linear regression analysis. Results: In the theoretical motion study (a), the MP detection errors are −0.2 ± 0.2, −1.5 ± 1.1, and −0.2 ± 0.2 mm for 2D, 3D, and 4D methods, respectively. Both the 2D and 4D methods could accurately detect motion pattern EX (error < 1.2 mm) and SD (error < 1.0 mm). In the patient motion study (b), MP detection error vector (mm) with the 2D method (0.7 ± 0.4) is found to be significantly less than with the 3D method (1.7 ± 0.8,p < 0.001) and the 4D method (1.4 ± 1.0, p < 0.001) using paired t-test. However, no significant difference is found between the 4D method and the 3D method. Based on multivariant linear regression analysis, the

  15. Integration between in vivo dosimetry and image guided radiotherapy for lung tumors.

    Science.gov (United States)

    Piermattei, Angelo; Cilla, Savino; Grimaldi, Luca; Sabatino, Domenico; Fidanzio, Andrea; Greco, Francesca; Mameli, Alessandra; Balducci, Mario; Mattiucci, Gian Carlo; Frascino, Vincenzo; Stimato, Gerardina; Gaudino, Diego; Ramella, Sara; Trodella, Lucio; D'Onofrio, Guido; Zini, Giampaolo; Macchia, Gabriella; Digesu', Cinzia; Morganti, Alessio G; Clemente, Stefania; Cozzolino, Mariella; Pedicini, Piernicola; Fusco, Vincenzo

    2009-06-01

    The article reports a feasibility study about the potentiality of an in vivo dosimetry method for the adaptive radiotherapy of the lung tumors treated by 3D conformal radiotherapy techniques (3D CRTs). At the moment image guided radiotherapy (IGRT) has been used for this aim, but it requires taking many periodic radiological images during the treatment that increase workload and patient dose. In vivo dosimetry reported here can reduce the above efforts, alerting the medical staff for the commissioning of new radiological images for an eventual adaptive plan. The in vivo dosimetry method applied on 20 patients makes use of the transit signal St on the beam central axis measured by a small ion chamber positioned on an electronic portal imaging device (EPID) or by the EPID itself. The reconstructed in vivo dosimetry at the isocenter point Diso requires a convolution between the transit signal St and a dose reconstruction factor C that essentially depends on (i) tissue inhomogeneities along the beam central axis and (ii) the in-patient isocenter depth. The C factors, one for every gantry angle, are obtained by processing the patient's computed tomography scan. The method has been recently applied in some Italian centers to check the radiotherapy of pelvis, breast, head, and thorax treatments. In this work the dose reconstruction was carried out in five centers to check the Diso in the lung tumor during the 3D CRT, and the results have been used to detect the interfraction tumor anatomy variations that can require new CT imaging and an adaptive plan. In particular, in three centers a small ion chamber was positioned below the patient and used for the St measurement. In two centers, the St signal was obtained directly by 25 central pixels of an a-Si EPID, equipped with commercial software that enabled its use as a stable detector. A tolerance action level of +/- 6% for every checked beam was assumed. This means that when a difference greater than 6% between the predicted

  16. Cultural Robotics: The Culture of Robotics and Robotics in Culture

    Directory of Open Access Journals (Sweden)

    Hooman Samani

    2013-12-01

    Full Text Available In this paper, we have investigated the concept of "Cultural Robotics" with regard to the evolution of social into cultural robots in the 21st Century. By defining the concept of culture, the potential development of a culture between humans and robots is explored. Based on the cultural values of the robotics developers, and the learning ability of current robots, cultural attributes in this regard are in the process of being formed, which would define the new concept of cultural robotics. According to the importance of the embodiment of robots in the sense of presence, the influence of robots in communication culture is anticipated. The sustainability of robotics culture based on diversity for cultural communities for various acceptance modalities is explored in order to anticipate the creation of different attributes of culture between robots and humans in the future.

  17. Stereotactic radiosurgery for the treatment of brain metastases; results from a single institution experience.

    LENUS (Irish Health Repository)

    Burke, D

    2013-09-01

    Stereotactic radiosurgery is frequently used for the treatment of brain metastases. This study provides a retrospective evaluation of patients with secondary lesions of the brain treated with stereotactic radiosurgery (SRS) at our institution.

  18. Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit

    DEFF Research Database (Denmark)

    Roug, Anne Stidsholt; Rasmussen, Åse Krogh; Juhler, M;

    2010-01-01

    To evaluate the effect of fractionated stereotactic radiotherapy (FSRT) in acromegaly in a retrospective analysis.......To evaluate the effect of fractionated stereotactic radiotherapy (FSRT) in acromegaly in a retrospective analysis....

  19. Dysuria Following Stereotactic Body Radiation Therapy for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Einsley-Marie eJanowski

    2015-07-01

    Full Text Available Background: Dysuria following prostate radiation therapy is a common toxicity that adversely affects patients’ quality of life and may be difficult to manage. Methods: 204 patients treated with stereotactic body radiation therapy (SBRT from 2007 to 2010 for localized prostate carcinoma with a minimum follow up of three years were included in this retrospective review of prospectively collected data. All patients were treated to 35-36.25Gy in 5 fractions delivered with robotic SBRT with real time fiducial tracking. Dysuria and other lower urinary tract symptoms were assessed via Question 4b (Pain or burning on urination of the Expanded Prostate Index Composite (EPIC-26 and the American Urological Association (AUA Symptom Score at baseline and at routine follow up. Results: 204 patients (82 low-, 105 intermediate-, and 17 high risk according to the D’Amico classification at a median age of 69 years (range 48-91 received SBRT for their localized prostate cancer with a median follow up of 47 months. Bother associated with dysuria significantly increased from a baseline of 12% to a maximum of 43% at one month (p<0.0001. There were two distinct peaks of moderate to severe dysuria bother at 1 month and at 6-12 months, with 9% of patients experiencing a late transient dysuria flare. While a low level of dysuria was seen through the first two years of follow-up, it returned to below baseline by two years (p=0.91. The median baseline AUA score of 7.5 significantly increased to 11 at 1 month (p<0.0001 and returned to 7 at 3 months (p= 0.54. Patients with dysuria had a statistically higher AUA score at baseline and at all follow-ups up to 30 months. Dysuria significantly correlated with dose and AUA score on multivariate analysis. Frequency and strain significantly correlated with dysuria on stepwise multivariate analysis.Conclusions: The rate and severity of dysuria following SBRT is comparable to patients treated with other radiation modalities.

  20. Soft Robotics Week

    CERN Document Server

    Rossiter, Jonathan; Iida, Fumiya; Cianchetti, Matteo; Margheri, Laura

    2017-01-01

    This book offers a comprehensive, timely snapshot of current research, technologies and applications of soft robotics. The different chapters, written by international experts across multiple fields of soft robotics, cover innovative systems and technologies for soft robot legged locomotion, soft robot manipulation, underwater soft robotics, biomimetic soft robotic platforms, plant-inspired soft robots, flying soft robots, soft robotics in surgery, as well as methods for their modeling and control. Based on the results of the second edition of the Soft Robotics Week, held on April 25 – 30, 2016, in Livorno, Italy, the book reports on the major research lines and novel technologies presented and discussed during the event.

  1. MAGNETIC RESONANCE IMAGING COMPATIBLE ROBOTIC SYSTEM FOR FULLY AUTOMATED BRACHYTHERAPY SEED PLACEMENT

    Science.gov (United States)

    Muntener, Michael; Patriciu, Alexandru; Petrisor, Doru; Mazilu, Dumitru; Bagga, Herman; Kavoussi, Louis; Cleary, Kevin; Stoianovici, Dan

    2011-01-01

    Objectives To introduce the development of the first magnetic resonance imaging (MRI)-compatible robotic system capable of automated brachytherapy seed placement. Methods An MRI-compatible robotic system was conceptualized and manufactured. The entire robot was built of nonmagnetic and dielectric materials. The key technology of the system is a unique pneumatic motor that was specifically developed for this application. Various preclinical experiments were performed to test the robot for precision and imager compatibility. Results The robot was fully operational within all closed-bore MRI scanners. Compatibility tests in scanners of up to 7 Tesla field intensity showed no interference of the robot with the imager. Precision tests in tissue mockups yielded a mean seed placement error of 0.72 ± 0.36 mm. Conclusions The robotic system is fully MRI compatible. The new technology allows for automated and highly accurate operation within MRI scanners and does not deteriorate the MRI quality. We believe that this robot may become a useful instrument for image-guided prostate interventions. PMID:17169653

  2. Rehabilitation robotics.

    Science.gov (United States)

    Krebs, H I; Volpe, B T

    2013-01-01

    This chapter focuses on rehabilitation robotics which can be used to augment the clinician's toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual's functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost.

  3. Medical robotics.

    Science.gov (United States)

    Ferrigno, Giancarlo; Baroni, Guido; Casolo, Federico; De Momi, Elena; Gini, Giuseppina; Matteucci, Matteo; Pedrocchi, Alessandra

    2011-01-01

    Information and communication technology (ICT) and mechatronics play a basic role in medical robotics and computer-aided therapy. In the last three decades, in fact, ICT technology has strongly entered the health-care field, bringing in new techniques to support therapy and rehabilitation. In this frame, medical robotics is an expansion of the service and professional robotics as well as other technologies, as surgical navigation has been introduced especially in minimally invasive surgery. Localization systems also provide treatments in radiotherapy and radiosurgery with high precision. Virtual or augmented reality plays a role for both surgical training and planning and for safe rehabilitation in the first stage of the recovery from neurological diseases. Also, in the chronic phase of motor diseases, robotics helps with special assistive devices and prostheses. Although, in the past, the actual need and advantage of navigation, localization, and robotics in surgery and therapy has been in doubt, today, the availability of better hardware (e.g., microrobots) and more sophisticated algorithms(e.g., machine learning and other cognitive approaches)has largely increased the field of applications of these technologies,making it more likely that, in the near future, their presence will be dramatically increased, taking advantage of the generational change of the end users and the increasing request of quality in health-care delivery and management.

  4. Rehabilitation robotics

    Science.gov (United States)

    KREBS, H.I.; VOLPE, B.T.

    2015-01-01

    This chapter focuses on rehabilitation robotics which can be used to augment the clinician’s toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual’s functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We will provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we will then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We will present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost. PMID:23312648

  5. Stereotactic localization and visualization of the subthalamic nucleus

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-gao; WANG Hai-yang; LIN Zhi-guo; SHEN Hong; CHEN Xiao-guang; FU Yi-li; GAO Wen-peng

    2009-01-01

    Background The subthalamic nucleus (STN) is widely recognized as one of the most important and commonly targeted nuclei in stereotactic and functional neurosurgery. The success of STN surgery depends on accuracy in target determination. Construction of a digitalized atlas of STN based on stereotactic MRI will play an instrumental role in the accuracy of anatomical localization. The aim of this study was to investigate the three-dimensional (3D) target location of STN in stereotactic space and construct a digitalized atlas of STN to accomplish the visualization of the STN on stereotactic MRI, thus providing clinical guidance on the precise anatomical localization of STN.Methods One hundred and twenty healthy people volunteered to be scanned by 1.5 Tesla MRI scanning with 1-mm-thick slice in the standard stereotactic space between 2005 and 2006. One adult male was selected for 3D reconstruction of STN. The precess of 3D reconstruction included identification, manual segmentation, extraction,conservation and reconstruction.Results There was a significant correlation between the coordinates and age (P <0.05). The volume of left STN was significantly larger than the right STN, and there was a significant negative correlation between volume and age (P <0.05).The surface of the STN nucleus after 3D reconstruction appeared smooth, natural and realistic. The morphological feature of STN on the individual brain could be visualized directly in 3D. The 3D reconstructed STN could be rotated,zoomed and displayed at any direction in the stereotactic space. The anteroposterior diameter of the STN nucleus was longer than the vertical and transverse diameters in 3D space. The 3D reconstruction of STN manifested typical structure of the "dual lens".Conclusions The visualization of individual brain atlas based on stereotactic MRI is feasible. However, software for automated segmentation, extraction and registration of MR images need to be further developed.

  6. Generic robot architecture

    Science.gov (United States)

    Bruemmer, David J [Idaho Falls, ID; Few, Douglas A [Idaho Falls, ID

    2010-09-21

    The present invention provides methods, computer readable media, and apparatuses for a generic robot architecture providing a framework that is easily portable to a variety of robot platforms and is configured to provide hardware abstractions, abstractions for generic robot attributes, environment abstractions, and robot behaviors. The generic robot architecture includes a hardware abstraction level and a robot abstraction level. The hardware abstraction level is configured for developing hardware abstractions that define, monitor, and control hardware modules available on a robot platform. The robot abstraction level is configured for defining robot attributes and provides a software framework for building robot behaviors from the robot attributes. Each of the robot attributes includes hardware information from at least one hardware abstraction. In addition, each robot attribute is configured to substantially isolate the robot behaviors from the at least one hardware abstraction.

  7. An efficient nano-based theranostic system for multi-modal imaging-guided photothermal sterilization in gastrointestinal tract.

    Science.gov (United States)

    Liu, Zhen; Liu, Jianhua; Wang, Rui; Du, Yingda; Ren, Jinsong; Qu, Xiaogang

    2015-07-01

    Since understanding the healthy status of gastrointestinal tract (GI tract) is of vital importance, clinical implementation for GI tract-related disease have attracted much more attention along with the rapid development of modern medicine. Here, a multifunctional theranostic system combining X-rays/CT/photothermal/photoacoustic mapping of GI tract and imaging-guided photothermal anti-bacterial treatment is designed and constructed. PEGylated W18O49 nanosheets (PEG-W18O49) are created via a facile solvothermal method and an in situ probe-sonication approach. In terms of excellent colloidal stability, low cytotoxicity, and neglectable hemolysis of PEG-W18O49, we demonstrate the first example of high-performance four-modal imaging of GI tract by using these nanosheets as contrast agents. More importantly, due to their intrinsic absorption of NIR light, glutaraldehyde-modified PEG-W18O49 are successfully applied as fault-free targeted photothermal agents for imaging-guided killing of bacteria on a mouse infection model. Critical to pre-clinical and clinical prospects, long-term toxicity is further investigated after oral administration of these theranostic agents. These kinds of tungsten-based nanomaterials exhibit great potential as multi-modal contrast agents for directed visualization of GI tract and anti-bacterial agents for phothothermal sterilization.

  8. Multifunctional biocompatible chitosan-polypyrrole nanocomposites as novel agents for photoacoustic imaging-guided photothermal ablation of cancer

    Science.gov (United States)

    Manivasagan, Panchanathan; Quang Bui, Nhat; Bharathiraja, Subramaniyan; Santha Moorthy, Madhappan; Oh, Yun-Ok; Song, Kyeongeun; Seo, Hansu; Yoon, Min; Oh, Junghwan

    2017-01-01

    Cancer nanotechnology is emerging as one of the promising strategies combining photothermal therapy (PTT) and photoacoustic imaging (PAI) for the treatment of breast cancer and it has received considerable attention in the recent years because it is minimally invasive, prevents damage to non-targeted regions, permits fast recovery, and involves breast cancer imaging. The present study demonstrates multifunctional biocompatible chitosan-polypyrrole nanocomposites (CS-PPy NCs) as novel agents for photoacoustic imaging-guided photothermal ablation of cancer because of their biocompatibility, conductivity, stability, and strong near-infrared (NIR) absorbance. The CS-PPy NCs are spherical in shape and range 26–94 nm in size with a mean value of 50.54 ± 2.56 nm. The in vitro results demonstrated good biocompatibility of CS-PPy NCs, which can be used in PTT for cancer cells under 808-nm NIR laser irradiation. Tumor-bearing mice fully recovered after treatment with CS-PPy NCs and NIR 808-nm laser irradiation compared to the corresponding control groups. Our research highlights the promising potential of using CS-PPy NCs for photoacoustic imaging-guided photothermal ablation of cancer in preclinical animals, which should be verified in future clinical trials. PMID:28252638

  9. Design and development of C-arm based cone-beam CT for image-guided interventions: initial results

    Science.gov (United States)

    Chen, Guang-Hong; Zambelli, Joseph; Nett, Brian E.; Supanich, Mark; Riddell, Cyril; Belanger, Barry; Mistretta, Charles A.

    2006-03-01

    X-ray cone-beam computed tomography (CBCT) is of importance in image-guided intervention (IGI) and image-guided radiation therapy (IGRT). In this paper, we present a cone-beam CT data acquisition system using a GE INNOVA 4100 (GE Healthcare Technologies, Waukesha, Wisconsin) clinical system. This new cone-beam data acquisition mode was developed for research purposes without interfering with any clinical function of the system. It provides us a basic imaging pipeline for more advanced cone-beam data acquisition methods. It also provides us a platform to study and overcome the limiting factors such as cone-beam artifacts and limiting low contrast resolution in current C-arm based cone-beam CT systems. A geometrical calibration method was developed to experimentally determine parameters of the scanning geometry to correct the image reconstruction for geometric non-idealities. Extensive phantom studies and some small animal studies have been conducted to evaluate the performance of our cone-beam CT data acquisition system.

  10. Image-guided radiofrequency ablation of Bosniak category III or IV cystic renal tumors: initial clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Kwan; Kim, Chan Kyo [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea); Lee, Hyun Moo [Sungkyunkwan University School of Medicine, Department of Urology, Samsung Medical Center, Seoul (Korea)

    2008-07-15

    The purpose of this study was to assess the efficacy of image-guided radiofrequency (RF) ablation of cystic renal tumors. Between November 2005 and August 2007, computed tomography (CT) or ultrasound-guided RF ablation was performed in nine patients with 14 Bosniak category III (n = 5) or IV (n = 9) cystic renal tumors using an internally cooled RF ablation system. We evaluated the number of sessions, cycles and duration of energy application, treatment results, lesion size change, and complications. Together the cystic renal tumors required 15 sessions and 23 cycles of energy application. The duration of energy application per one tumor ablation ranged from 1 to 12 min (mean 6 min). The last follow-up CT indicated complete coagulation of 14/14 (100%) lesions. None of these tumors had recurred within 1-19 months (mean 8 months). The maximum diameter of the cystic renal tumors was significantly reduced from 2.5 {+-} 0.6 cm before ablation to 1.7 {+-} 0.7 cm at the last follow-up CT (P < 0.01). Complications were pneumothorax (n = 2), inguinal paresthesia (n = 1), and arteriovenous fistula (n = 1). Image-guided RF ablation is an effective treatment for Bosniak category III or IV cystic renal tumors, which might need relatively shorter duration of energy application than purely solid renal tumors of the same size. (orig.)

  11. Automated tru-cut imaging-guided core needle biopsy of canine orbital neoplasia. A prospective feasibility study.

    Science.gov (United States)

    Cirla, A; Rondena, M; Bertolini, G

    2016-01-01

    The purpose of this study was to evaluate the diagnostic value of imaging-guided core needle biopsy for canine orbital mass diagnosis. A second excisional biopsy obtained during surgery or necropsy was used as the reference standard. A prospective feasibility study was conducted in 23 canine orbital masses at a single centre. A complete ophthalmic examination was always followed by orbital ultrasound and computed tomography (CT) examination of the head. All masses were sampled with the patient still on the CT table using ultrasound (US) guided automatic tru-cut device. The most suitable sampling approach to the orbit was chosen each time based on the CT image analysis. One of the following different approaches was used: trans-orbital, trans-conjunctival or trans-masseteric. In all cases, the imaging-guided biopsy provided a sufficient amount of tissue for the histopathological diagnosis, which concurred with the biopsies obtained using the excisional technique. CT examination was essential for morphological diagnosis and provided detailed topographic information that allowed us to choose the safest orbital approach for the biopsy. US guided automatic tru-cut biopsy based on CT images, performed with patient still on the CT table, resulted in a minimally invasive, relatively easy, and accurate diagnostic procedure in dogs with orbital masses.

  12. Activatable Multifunctional Persistent Luminescence Nanoparticle/Copper Sulfide Nanoprobe for in Vivo Luminescence Imaging-Guided Photothermal Therapy.

    Science.gov (United States)

    Chen, Li-Jian; Sun, Shao-Kai; Wang, Yong; Yang, Cheng-Xiong; Wu, Shu-Qi; Yan, Xiu-Ping

    2016-12-07

    Multifunctional nanoprobes that provide diagnosis and treatment features have attracted great interest in precision medicine. Near-infrared (NIR) persistent luminescence nanoparticles (PLNPs) are optimal materials due to no in situ excitation needed, deep tissue penetration, and high signal-to-noise ratio, while activatable optical probes can further enhance signal-to-noise ratio for the signal turn-on nature. Here, we show the design of an activatable multifunctional PLNP/copper sulfide (CuS)-based nanoprobe for luminescence imaging-guided photothermal therapy in vivo. Matrix metalloproteinases (MMPs)-specific peptide substrate (H2N-GPLGVRGC-SH) was used to connect PLNP and CuS to build a MMP activatable system. The nanoprobe not only possesses ultralow-background for in vivo luminescence imaging due to the absence of autofluorescence and optical activatable nature but also offers effective photothermal therapy from CuS nanoparticles. Further bioconjugation of c(RGDyK) enables the nanoprob