Critical Review Computer Integrated Surgery II Adam Clayton Review paper: Robotic system for prostate brachytherapy Robotic system for prostate brachytherapy. Yu Y, Podder TK, Zhang YD, Ng WS, Misic V, Sherman J, Fuller D, Rubens DJ, Strang JG, Brasacchio RA, Messing EM. Comput Aided Surg Nov;12(6):

My Robotic Prostate Brachytherapy Research Integration of RadVision simulation software with TRUS robot Purpose is to achieve greater accuracy in seed implantation Plan to perform accuracy experiments

Summary – Prostate Brachytherapy Needles are inserted under the guidance of transrectal ultrasound (TRUS) images Manual control of both ultrasound unit and needle Grid of holes serves as physical template

Summary – Problems with conventional approach Limited of inflexibility and maneuverability induced by physical template. Difficulty in avoiding pubic arch. Consistency and efficiency of the treatment depends on the clinicians

Summary – Benefits of Robotic Brachytherapy Improved accuracy Improved consistency especially with younger, less experienced surgeons. Improved efficiency

Previous Brachytherapy Robots Acubot Cartesian bridge with 3-DOF 7-DOF robotic arm 1-DOF needle inserter with motorized driver Seeds deposited manually Lacked precision in needle insertion

Summary - Previous Brachytherapy Robots Used a Thermo-CRS industrial robot with 6- DOF 3D ultrasound system Industrial robot loss dexterity in confined space

Summary – Euclidean design goals improve accuracy of needle placement and seed delivery improve avoidance of critical structures (urethra, pubic arch, bladder, etc.) update dosimetry after each needle is implanted (automatic seed localization) detect tissue heterogeneities and deformation via force sensing and imaging feedback reduce trauma and edema reduce radiation exposure; reduce the learning curve reduce OR time.

Summary – Euclidean System Consists of 3 modules; 9-DOF positioning module and 7-DOF surgery module Positioning module consists of 3-DOF cart and 6-DOF platform

Summary – Euclidean Positioning System The 3-DOF cart move in x-y horizontal plane and rotate on vertical axis. The 6-DOF platform is able to translate in 3-DOF and rotate in 3-DOF

Summary - Surgery Module Consists of 2-DOF ultrasound probe driver, a 3-DOF gantry, a 2-DOF needle driver, a seed pusher, and a teach- pendant 3-DOF Gantry for positioning needle in vertical plane one for rotation

Summary - Surgery Module 2-DOF ultrasound probe driver can be translated and rotated by its long axis 2-DOF needle driver that translates and rotates

Summary - Clinical Procedure 3D model created by ultrasound scan 3D model used to plan insertion Gantry used to position needle at correct position and angle for insertion Needle drive mechanism inserts needle to predefined depth Clinician pendant to insert needle to final depth Clinician inserts seed Upon request validation state will validate seed placement with scan

Summary – Experimental Results Run for two hours at a time 18-gauge beveled-tip brachytherapy needle was inserted into a graph paper pasted on the front of a foam block with 16 penetration location in 60 mm x 60 mm Repeated 100 times Optical images used to access accuracy Accuracy was +-.2 mm with standard deviation.045 mm

Summary – PVC Phantom Experimental Results Phantom gel implanted with seeds 1 cm apart Accuracy(RMS error) in x-axis is.67 mm with standard deviation of.58 mm Accuracy(RMS error) in y-axis is.13 mm with standard deviation of.12 mm Accuracy(RMS error) in z-axis is.11 mm with standard deviation of.11 mm Within acceptable clinical results of 2 mm

Summary - Conclusion Improved insertion accuracy and seed delivery errors Automatic and semi-automatic operation Operator can switch into conventional manual mode Currently undergoing IRB review (at time of paper submission)

Critique – Superfluous details Complete functional requirements specification unnecessary ex. compatible with sterilization procedures. Specific computer details such as processor, clock speed, amount of RAM, and etc Exact dimensions and weight of some components

Critique – Phantom gel experiment lacked important details the number of samples gathered to compile statistics depth of seed implantation Method used to measure accuracy Would recommend using standardized test (if one exists)

Critique - Introduction Provided clear reasoning and answers to the questions the purpose of the research was to eliminate problems of conventional brachytherapy Clear objective - “It presents the detailed design and development of a prototype robotic system called Euclidean, the sequence of operations when using Euclidean in clinical procedures, and the results of preliminary experiments to evaluate Euclidean’s accuracy and repeatability in prostate seed implantation.” Briefly talked about previous work in field.

Critique – Good breakdown and explanation of system design Good explanation of each major component as well as how they fit together Good pictures and diagrams showing entire system and components

Conclusion Good development and research To much detail in design and development section Not enough detail in experiments Good introduction Good experimentation