Special topic breakout: IGT for Prostate

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Prostate IGT Breakout Session

June 26th, 11am-noon

Location: Grier Rooms A & B: 34-401A & 34-401B

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
• System design draft proposed by Csaba (JHU)

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.

1. 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.

Procedure:

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

Post-Procedure:

1. Retract needle. VERIFY no contact with patient.
2. Disengage robot latch and slide to robot base of cradle.
3. Remove needle from driver, extract final sample.
4. Slide robot off of cradle and place back onto its own cart.
5. Transfer patient out of scanner.
6. Decouple imaging coils.
7. Allow patient to emerge from anesthesia, disconnect from appropriate equipment.
8. Wheel patient to recovery room.
9. Room cleanup.

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

Work phases

-Preparation -Planning -Calibration -Targeting -Manual operation -Emergency

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

System Design (Draft)

See U41:Prostate:BRP:SystemDesign_Jun2007.