View source for Special topic breakout: IGT for Prostate

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<br><br><br><br>

Prostate IGT Breakout Session

June 26th, 11am-noon

Location: [[Meeting_Locations:MIT_Grier_A_%26B|Grier Rooms A & B: 34-401A & 34-401B]]

<br> <br> <br><br>

=Invited Attendees=
*Clare Tempany, BWH 
*Clif Burdette, Acousticmed
*Jack Blevins, Acousticmed
*Greg Fischer, JHU
*Gabor Fichtinger, Queens
*Csaba Csoma, JHU
*David Gobbi, Queens
*Purang Abolmaesumi, Queens
*Robert Cormack, BWH
*Junichi Tokuda, BWH
*Haiying Liu, BWH

=Agenda=

==Technical updates==
2-3 slides from each site.
===BWH===
*Scanner control interface (NaviTrack)
*Real-time image transfer interface (NaviTrack)
*Z-frame tracking for manipulator calibration
*3D Slicer 3.0 prostate module

===JHU===
*Movie: CAD simulation of the robot
*Q&A about the robot and the controller interface
*[http://www.cisst.org/wiki/MRI_Robot:System_design System design draft proposed by Csaba (JHU)]

===Acoustic Med===

==Clinical workflow==
==Proposal==

===Preparation/Calibration===
====Procedure Room:====
* Robotic device located in suite (base unit). The robot will have its own cart.
* Master physician interface console located in suite (corner of room). The console will have its own cart.
* Robot controller unit located in machine room.
* Connections to pressurized air (in room).
* Connections between robotic device and control unit in machine room, via penetration panel. [interface requirements TBD]
* Connections between master interface and control unit in machine room, via penetration panel. [interface requirements TBD]
* Perform robot test and calibration (outside of magnet).
* Anesthesia and patient monitoring equipment setup.
* Biopsy kit [contents TBD] on dedicated side table.
#note---
* Sterile needle driver kit and needles.
* Sterilization and draping kit [magnet, leg support, robot sterilization TBD]
* Imaging coils [endorectal and/or surface coil TBD]
* Plan view of room layout shown above.

====Control Room:====
* Navigation software setup (3D Slicer and Burdette System—details TBD)
* Connect and test communication between navigation system and scanner host.

====Scanner:====
* Navigation systems check/calibration.
* Draping [requirements TBD].

====Patient (Prep Room):====
* Patient arrives in prep/holding room.
* Consent for interventional procedure and for studies associated with the IRB protocol.
* Pre-preparation of perineum (shave hair, etc.)
* Place endorectal imaging coil (patient lateral decubitus).
* Position patient in supine position, with legs slightly raised on leg support. (note: custom SIGNA cradle/transfer-board)
* Check bore clearance using template.
* Place IV lines and initiate sedative medications.

<br>
===Procedure:===
# Patient moved from prep/holding area to MRI suite [use SIGNA table or Transmobile?].
# Dock SIGNA table or transfer patient from Transmobile. [?]
# Connect vital signs monitor to patient.
# Induce anesthesia.
# Place Foley catheter.
# Place surface coil, apply padding, pneumatic cuffs and patient warming blanket.
# Prepare perineum (iodine, etc.).
# Place sterile insert into leg support tunnel and complete final positioning of leg support against perineum. 
# Check bore clearance using template and secure legs.
# MR SAFETY PAUSE:
## Instrument count
## Secure all equipment
## Tether tubing
## Get clearance to move from anesthesiologist
# Connect imaging coils and slide patient into scanner.
# Acquire localizer images; reposition patient as necessary.
# Drape robot base and place onto linear track at base of SIGNA table.
# Attach sterile needle driver and load first biopsy needle.
# Final robot motion test. Drive robot to initial configuration, with needle fully retracted.
# Slide robot into access tunnel and engage end-stop latch.
# Acquire robot calibration images. [FGRE – protocol TBD]
# Acquire pre-procedural images and registered to pre-operative data. [T2W images]
# Treatment planning will take place and be reviewed by the team.
# Needle and robot trajectories will be verified using pre-procedural images and robot calibration. Re-plan as necessary.
# Position and orient needle trajectory for current target, using in-room console.
# Interventional image: in plane of needle (FGRE); visualize with pre-procedural axial image at target. VERIFY trajectory on computer display.
# Advance needle using in-room master physician interface console. Real-time imaging and fused navigation display.
# Advance biopsy mechanism, followed by short imaging sequence (FGRE) to verify positioning against fused data set.
# Fire biopsy gun.
# Retract needle. VERIFY no contact with patient.
# Disengage robot latch and slide robot to base of cradle.
# Remove needle from driver, extract biopsy sample, replace needle into driver.
# Slide robot into access tunnel and engage end-stop latch.
# Repeat steps 21-29 for each biopsy sample.

<br>
===Post-Procedure:===
# Retract needle. VERIFY no contact with patient.
# Disengage robot latch and slide to robot base of cradle.
# Remove needle from driver, extract final sample.
# Slide robot off of cradle and place back onto its own cart.
# Transfer patient out of scanner.
# Decouple imaging coils.
# Allow patient to emerge from anesthesia, disconnect from appropriate equipment.
# Wheel patient to recovery room.
# Room cleanup.

<br>
===Emergency Procedures and Contingencies:===

====Patient Code====
* Detail required.

====Scanner Malfunction====
* Detail required.

====Robot Malfunction====
* Detail required.

===Issues===
*State (mode) transition

==System diagram and Work phases==
[[Image:ProjectWeek2007-IGTProstate-system.png]]
===Issues===
Suggested by Csaba:
*Connection between RT Scanner IO and Robot Controller.
**The robot controller should get z-frame postion data from the navigation software
*Recovering packet loss (especially for command events).
**Each subsystem keeps sending status information every several seconds / or ACK message when command received

==Work phases==
*Preparation
*Planning
*Calibration
*Targeting
*Manual operation
*Emergency

===Preparation===
[[Image:ProjectWeek2007-IGTProstate-PreparationPhase.png]]

===Planning===
[[Image:ProjectWeek2007-IGTProstate-PlanningPhase.png]]

===Calibration===
[[Image:ProjectWeek2007-IGTProstate-CalibrationPhase.png]]

===Targeting===
[[Image:ProjectWeek2007-IGTProstate-TargetingPhase.png]]

===Manual operation===
[[Image:ProjectWeek2007-IGTProstate-ManalPhase.png]]

===Emergency===
[[Image:ProjectWeek2007-IGTProstate-EmergencyPhase.png]]

=System Design (Draft)=

See [[U41:Prostate:BRP:SystemDesign_Jun2007]].