1. Autonomous Robotics in Medicine Michael Saracen February 11, 2009

2. Agenda Advances in Medicine Problem Opportunity Current use of Robotics Case Studies Summary

3. Advances in Medicine Medicine continues to grow and expand regardless of economic situation Advances are increasing lifespan Computers have entered medicine and driving new technologies Minimally invasive procedures are driving costs and complications down Greater demand for precision and accuracy

4. Advances in Medicine Advances in diagnostics are driving more targeted treatments Treating disease while sparing healthy tissue Advances in imaging are altering treatment Early detection provides more options Combining modalities improves treatment

5. Better Targeting

8. Everything is relative…

9. What we want to avoid…

11. Why Robotics? Mobility Repeatability Precision Accuracy

12. Medical Robotics Positioning Ultrasound Probe Hospital Courier Telemedicine In-Vivo Surgery Patient Assistant Mixing Chemotherapy Drugs OperationalProcedural Surgical Component Non-invasive Radiation

13. Medical Robotics Various functions Improve operational efficiencies Interact with Patient Patient Telemedicine Patient aide Employed in procedures Types of control Autonomous – CyberKnife treatment Programmable – Robotic patient positioner Master slave – Da Vinci

14. Linear Accelerator Manipulator Image Detectors X-ray Sources IMAGING SYSTEM ROBOTIC DELIVERY SYSTEM TARGETING SOFTWARE

15. Case Study 1 Robotic Patient Positioning

16. Conventional Treatment Couch Limited Mobility Only four degrees of freedom Fixed mechanical axis Limited repeatability No spatial relationship between each axis Manually driven Limited loading positions Limited treatment positions

17. The Problem… Patients can be positioned differently from simulation to treatment Cannot account for rotations Manual movement of the couch is often jerky and less accurate Iterative process Accuracy is often compromised for time (maintain high throughput) Complex immobilization devices are required to position patient Breast treatments

18. Current Couch Limitations Patient marks External Patient Marks Simulation Treatment Room Lasers Rotation Inaccuracy

19. Benefits of Robotic Positioning Room Lasers Rotation Inaccuracy Absolution Correction

20. Design Considerations Reach Clearance Comfort Intimidation factor Footprint

21. Design Considerations

22. A5 A6 A4 A3 A2 A1

23. Safety Consideration Software limits on robot controller Limit switches on the robot “wrist” to prevent excess rotations Limit switches on the vertical travel Contact detection on upper arm of robot Enable button on hand pendant E-Stop button on hand controller Couch can lower for patient egress during power outage