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Robotically assisted long bone biopsy under MRI: cadaver study results

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Abstract

Rationale and objectives

We have designed and constructed an MR-safe robot made entirely of nonmetallic components with pneumatic actuators and optical encoders. The robot was developed to enable bone biopsies to be performed under magnetic resonance imaging (MRI) guidance in pediatric patients. The purpose of this study was to show the feasibility of using the robot for biopsy of the femur and tibia in a cadaver leg. Our long-term goal is to eliminate radiation exposure during bone biopsy procedures and provide more timely and accurate diagnosis for children with bone cancers and bone infections.

Methods

The MR-safe robot was mounted on the MRI table. A cadaver leg was procured from an anatomy supply house and placed on the MRI table. All required hospital precautions for infection control were taken. A total of 10 biopsy targets were sampled using MRI guidance: five from the femur and five from the tibia. A handheld, commercially available battery-powered bone drill was used to facilitate drilling through the cortex. After the study, the leg was scanned with CT to better visualize and document the bone biopsy sites. Both the MRI and CT images were used to analyze the results.

Results

All of the targets were successfully reached with an average targeting accuracy of 1.43 mm. A workflow analysis showed the average time for the first biopsy was 41 min including robot setup time and 22 min for each additional biopsy including the time for the repeat MRI scan used to confirm accurate targeting. The robot was shown to be MRI transparent, as no image quality degradation due to the use of the robot was detected.

Conclusion

The results showed the feasibility of using an MR-safe robotic system to assist the interventional radiologist in performing precision bone biopsy under MRI guidance. Future work will include developing an MR-safe drill, improving the mounting of the robot and fixation of the leg, and moving toward first in child clinical trials.

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Acknowledgements

We would also like to thank the MRI technologists Lu Vargas and Shena Phillips for their help with the experimental studies, as well as Dr. Xiaoyan Song from infection control.

Funding

This research was funded by the NIH Grant R01CA172244, Pneumatic Robot for MRI-Guided Long Bone Biopsy. The MR-safe robot technology developments were supported in part by awards RC1EB010936 from the National Institute of Biomedical Imaging and Bioengineering, and W81XWH0810221 from the Department of Defense. This research was also supported by the Intramural Research Program of the National Institutes of Health, National Heart, Lung, and Blood Institute, HHSN268200900052C.

Author information

Author notes

  1. Sunghwan Lim and Karun Sharma have contributed equally to this work and should be co-first authors.

  2. Dan Stoianovici and Kevin Cleary have contributed equally to the project organization and execution and should be co-last authors.

Authors and Affiliations

  1. Robotics Laboratory, Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA

    Sunghwan Lim, Pan Li, Doru Petrisor & Dan Stoianovici

  2. Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Avenue, Washington, DC, USA

    Karun Sharma, Stanley Fricke & Kevin Cleary

Authors
  1. Sunghwan Lim
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  2. Karun Sharma
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  6. Dan Stoianovici
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  7. Kevin Cleary
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Corresponding author

Correspondence to Kevin Cleary.

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Lim, S., Sharma, K., Li, P. et al. Robotically assisted long bone biopsy under MRI: cadaver study results. Int J CARS 14, 147–156 (2019). https://doi.org/10.1007/s11548-018-1889-1

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