Purpose: The purpose is to design and validate an anthropomorphic polyvinyl alcohol (PVA) liver phantom with respiratory motion to simulate needle-based interventions. Such a system can, for example, be used as a validation tool for novel needles. Methods: Image segmentations of CT scans of four patients during inspiration and expiration were used to measure liver and rib displacement. An anthropomorphic liver mold based on a CT scan was 3D printed and filled with 5% w/w PVA-to-water, undergoing two freeze–thaw cycles, in addition to a 3D-printed compliant rib cage. They were both held in place by a PVA abdominal phantom. A sinusoidal motion vector, based on the measured liver displacement, was applied to the liver phantom by means of a motion stage. Liver, rib cage and needle deflection were tracked by placing electromagnetic sensors on the phantom. Liver and rib cage phantom motion was validated by comparison with the CT images of the patients, whereas needle deflection was compared with the literature. Results: CT analysis showed that from the state of expiration to inspiration, the livers moved predominantly toward the right (mean: 2 mm, range: − 11 to 11 mm), anterior (mean: 15 mm, range: 9–21 mm) and caudal (mean: 16 mm, range: 6–24 mm) direction. The mechatronic design of the liver phantom gives the freedom to set direction and amplitude of the motion and was able to mimic the direction of liver motion of one patient. Needle deflection inside the phantom increased from 1.6 to 3.8 mm from the initial expiration state to inspiration. Conclusions: The developed liver phantom allows for applying different motion patterns and shapes/sizes and thus allows for patient-specific simulation of needle-based interventions. Moreover, it is able to mimic appropriate respiratory motion and needle deflection as observed in patients.

@en

Liver carcinoma is in the top five leading causes of cancer death worldwide. Patients often require radiologic interventions in which needles are inserted, for example when taking biopsies, accessing blood vessels or bile ducts, and ablating tumors. Accurate and precise needle placement in interventional radiology is important, but also challenging. Challenges include several factors, such as anatomical obstructions along the insertion path, patient motion, and unwanted needle bending upon insertion. Incorrect needle placement may prolong procedure time, increase radiation dose for the patient and may cause complications. Proposed approaches to improve needle placement in interventional radiology include, but are not limited to, steerable needles and liver phantoms. Although steerable needles are technically feasible to produce, these prototypes are often general-purpose. Currently, there is a lack of (analyzed) clinical and experimental data that provide insight into needle placement, and that would clarify the right design requirements for novel needles in interventional radiology. Another gap exists in the development of liver phantoms, which can be used in a validation set-up for novel needles and/or a training model for medical doctors. Current phantom development focusses mostly on medical imaging properties. However, matching needle-tissue interaction forces and simulating breathing motion are also crucial for a phantom to be of use in a realistic validation set-up. Therefore, the objectives of this thesis are to define relevant design considerations for novel needles, and to develop a high fidelity liver phantom that features respiratory motion and that mimics needle-tissue interaction forces upon insertion. Accomplishing this will improve and advance needle placement in interventional radiology. @en

Introduction: Accurate needle placement is crucial in image-guided needle interventions. A targeting error may be introduced due to undesired needle deflection upon insertion through tissue, caused by e.g. patient breathing, tissue heterogeneity, or asymmetric needle tip geometries. This paper aims to quantify needle deflection in thermal ablation procedures of liver tumors by means of a CT image analysis. Methods: Needle selection was done by using all clinical CT data that were made during thermal ablation procedures of the liver, ranging from 2008-2016, in the Erasmus MC, the Netherlands. The 3D needle shape was reconstructed for all selected insertions using manual segmentation. Subsequently, a straight line was computed between the entry point of the needle into the body and the needle tip. The maximal perpendicular distance between this straight line and the actual needle was used to calculate needle deflection. Results: In total, 365 needles were included in the analysis ranging from 14G to 17G in diameter. Average needle insertion depth was 95mm (range: 32 mm – 182 mm). Needle deflection was on average 1.3 mm (range: 0.0 mm – 6.5 mm). 54% of the needles (n=196) had a needle deflection of more than one millimeter, whereas 7% of the needles (n=25) showed a large needle deflection of more than three millimeters.
Conclusions: Needle deflection in interventional radiology occurs in more than half of the needle insertions. Therefore, deflection should be taken into account when performing procedures and when defining design requirements for novel needles. Further, needle insertion models need to be developed that account for needle deflection. @en

Purpose: Accurate and precise needle placement is of utmost importance in interventional radiology. However, targeting can be challenging due to, eg, tissue motion and deformation. Steerable needles are a possible solution to overcome these challenges. The present work studied the clinical need for steerable needles. We aimed to answer three subquestions: 1) What are the current challenges in needle placement? 2) What are allowable needle placement errors? and 3) Do current needles need improvement and would steerable needles add clinical value?
Methods: A questionnaire was administered at the Annual Meeting of ­Cardiovascular and Interventional Radiology Society of Europe in 2016. In total, 153 respondents volunteered to fill out the survey, among them 125 (interventional) radiologists with experience in needle placement.
Results: 1) Current challenges in needle placement include patient-specific and technical factors. Movement of the target due to breathing makes it most difficult to place a needle (90%). 2) The mean maximal allowable needle placement error in targeted lesions is 2.7 mm. A majority of the respondents (85%) encounter unwanted needle bending upon insertion. The mean maximal encountered unwanted needle bending is 5.3 mm. 3) Needles in interventional radiology need improvement, eg, improved needle visibility and manipulability, according to 95% of the respondents. Added value for steerable needles in current interventions is seen by 93% of the respondents.
Conclusion: Steerable needles have the potential to add clinical value to radiologic interventions. The current data can be used as input for defining clinical design requirements for technical tools, such as steerable needles and navigation models, with the aim to improve needle placement in interventional radiology.@en

A needle-tissue interaction experiment has been carried out, by inserting the inner needle of a trocar needle into two ex-vivo human livers. The dataset contains the forces that act on the needle during insertion and retraction into the livers. In addition, a MATLAB code file is included that provides base-level analysis of the data and generates force-position diagrams of the needle insertions. The dataset is available on Mendeley Data (do1i:10.17632/94s7xd9mzt.2), and is made publicly available to enable other researchers to use it for their own research purposes. For further interpretation and discussion of the data, one is referred to the associated research article entitled “PVA matches human liver in needle-tissue interaction” de Jong et al., 2017.@en

Steering of needles involves the planning and timely modifying of instrument-tissue force interactions to allow for controlled deflections during the insertion in tissue. In this work, the effect of tip shape on these forces was studied using 10 mm diameter needle tips. Six different tips were selected, including beveled and conical versions, with or without pre-bend or pre-curve. A six-degree-of-freedom force/torque sensor measured the loads during indentations in tissue simulants. The increased insertion (axial) and bending (radial) forces with insertion depth-the force-displacement slopes-were analyzed. Results showed that the ratio between radial and axial forces was not always proportional. This means that the tip load does not have a constant orientation, as is often assumed in mechanics-based steering models. For all tip types, the tip-load assumed a more radial orientation with increased axial load. This effect was larger for straight tips than for pre-bent or pre-curved tips. In addition, the force-displacement slopes were consistently higher for (1) increased tip angles, and for (2) beveled tips compared to conical tips. Needles with a bent or curved tip allow for an increased bending force and a decreased variability of the tip load vector orientation.

@en

Medical phantoms can be used to study needle-tissue interaction and to train medical residents. The purpose of this research is to study the suitability of polyvinyl alcohol (PVA) as a liver tissue mimicking material in terms of needle-tissue interaction. Insertions into ex-vivo human livers were used for reference. Six PVA samples were created by varying the mass percentage of PVA to water (4 m% and 7 m%) and the number of freeze-thaw cycles (1, 2 and 3 cycles, 16 hours of freezing at −19 °C, 8 hours of thawing). The inner needle of an 18 Gauge trocar needle with triangular tip was inserted 13 times into each of the samples, using an insertion velocity of 5 mm/s. In addition, 39 insertions were performed in two ex-vivo human livers. Axial forces on the needle were captured during insertion and retraction and characterized by friction along the needle shaft, peak forces, and number of peak forces per unit length. The concentration of PVA and the number of freeze-thaw cycles both influenced the mechanical interaction between needle and specimen. Insertions into 4 m% PVA phantoms with 2 freeze-thaw cycles were comparable to human liver in terms of estimated friction along the needle shaft and the number of peak forces. Therefore, these phantoms are considered to be suitable liver mimicking materials for image-guided needle interventions. The mechanical properties of PVA hydrogels can be influenced in a controlled manner by varying the concentration of PVA and the number of freeze-thaw cycles, to mimic liver tissue characteristics.

@en

Motion analysis is employed to assess minimally invasive surgical psychomotor skills in box trainers. Tracking of laparoscopic instruments requires sensor-based systems that can be expensive, limit movements and modify their ergonomic properties. We evaluate the feasibility of using Leap Motion as a cheap, unobtrusive alternative. Four experiments were performed to determine its precision while tracking a laparoscopic instrument inside and outside a box trainer. Static long and short term precision of the Leap Motion was <2.5 mm. Precision between 12 different positions within the box trainer was <0.7 mm for all measured distances between neighbors. Dynamic precision when moving the instrument for 200 mm ranged between 2 and 15 mm. Leap Motion presents acceptable precision values inside a box trainer. Improvements are still required (e.g.: multiple instruments’ tracking). Once solved, a validation study should verify the usefulness of Leap Motion to objectively measure skills of novices and residents during training.@en