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Research Papers

# A Precision System for Computed Tomography-Guided Needle Placement in the Thorax and Abdomen—Technical Design and Performance Analysis

[+] Author and Article Information
Maarten M. Arnolli

Enschede 7521 PH, The Netherlands;
Precision Engineering
Science-Based Engineering,
University of Twente,
Enschede 7522 NB, The Netherlands
e-mail: m.m.arnolli@alumnus.utwente.nl

Martijn Buijze, Michel Franken

Enschede 7521 PH, The Netherlands

Ivo A. M. J. Broeders

Robotics and Mechatronics,
MIRA Institute for Biomedical Technology and
Technical Medicine,
University of Twente,
Enschede 7522 NB, The Netherlands

Dannis M. Brouwer

Precision Engineering
Science-Based Engineering,
University of Twente,
Enschede 7522 NB, The Netherlands

1Corresponding author.

Manuscript received May 23, 2017; final manuscript received January 30, 2018; published online April 2, 2018. Assoc. Editor: Carl Nelson.

J. Med. Devices 12(2), 021003 (Apr 02, 2018) (10 pages) Paper No: MED-17-1231; doi: 10.1115/1.4039389 History: Received May 23, 2017; Revised January 30, 2018

## Abstract

A system was developed for computed tomography (CT)-guided needle placement in the thorax and abdomen, providing precise aiming of a needle guide (NG) to reach a user-specified target in a single manual insertion. The objective of this work is to present its technical design and analyze its performance in terms of placement error in air. The individual contributions to the placement error of a fiducial marker based system-to-CT registration system, a two degrees-of-freedom (2DOFs) drive system to aim the NG, and a structural link between NG and CT table were experimentally determined, in addition to the placement error of the overall system. An error contribution of 0.81 ± 0.34 mm was determined for the registration system, <1.2 mm and <3.3 mm for the drive system, and 0.35 mm and 0.43 mm for two load cases of the structural link. The overall unloaded system achieved 1.0 ± 0.25 mm and 2.6 ± 0.7 mm at 100 mm and 250 mm depth, respectively. The overall placement errors in air do not exceed the $≤$5 mm error specified as a clinical user requirement for needle placement in tissue.

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## References

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## Figures

Fig. 1

Overview of the system with labeled components

Fig. 2

Illustration of the system's guided method for needle placement. An animation can be found online [9]: (a) the system installed on the patient table, awaiting initial path planning and entry point retrieval, (b) manual placement of the OM such that the RCM coincides with the entry point and push-button controlled locking to the patient table by the LM, (c) CT scanning of patient and OM for OM-to-CT registration using four fiducial markers and for target specification, (d) automated aiming of the NG by the RCM mechanism, (e) manual needle insertion through the NG to specified depth, and (f) CT scanning for placement verification.

Fig. 3

System internals, showing the fiducial markers and the drive system

Fig. 4

Computed tomography scanning of the dummy frame to determine the contribution of the registration system to the placement error: (a) CT scanning of the dummy frame on a foam support and (b) 3D CT image of the dummy frame

Fig. 5

Mean value, standard deviation, minimum and maximum (filled areas) of FREs (Eq. (2)) and TRE (Eq. (8)) as a function of pixel value threshold level used for segmentation, accompanied by the number of successful segmentations out of eight CT scans

Fig. 6

Kinematic diagram of the transmission from worms to segments, converted from the rotational to the translational domain for illustrative purposes. Diagonal cross-hatching indicates connection to the fixed frame of reference of the MB of the OM.

Fig. 7

Experiment setups to determine the error contribution of the drive system: (a) measuring the angle of segment 1 and (b) measuring the angle of segment 2

Fig. 8

Angular errors of the drive system and equivalent placement errors at a target depth of 250 mm: (a) transmission errors for worm 1 to segment 1 and (b) transmission errors for worm 2 to segment 2

Fig. 9

Cross section of the system, labeling the materials forming the structural link

Fig. 10

Experiment setups to determine the compliances of the structural link from NG to table: (a) measurement of deflections dx1, dx2, and dy1 under load FyMB by mass m1 on the MB of the OM, and corresponding deflection diagram and (b) measurement of deflections dy2 and dy3 under load FyS2 by mass m2 on segment 2 (S2), and corresponding deflection diagram

Fig. 11

Determining the placement error of the overall system: (a) the system is installed on the CT table and the OM is locked. The center of a fiducial marker on a PVC rod serves as a target, (b) 3D CT image of the OM and target fiducial marker for OM-to-CT registration and definition of the target coordinates, (c) the target fiducial marker is replaced by a rod with a conical end, to measure the placement error after needle placement, and (d) illustration of ten target positions at 100 and 250 mm depth from the RCM and corresponding placement errors.

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