Cooperative Robotic Gamma Imaging: Enhancing US-guided Needle Biopsy
Sentinel lymph node (sLN) biopsy mostly requires an invasive surgical intervention to remove sLNs under radioguidance. We present an alternative method where live ultrasound is combined with live robotic gamma imaging to provide real-time anatomical and n
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Computer Aided Medical Procedures (CAMP) Technische Universit¨ at M¨ unchen, Germany 2 Computer Aided Medical Procedures Johns Hopkins University, US 3 FRAMOS GmbH, Taufkirchen, Germany
Abstract. Sentinel lymph node (sLN) biopsy mostly requires an invasive surgical intervention to remove sLNs under radioguidance. We present an alternative method where live ultrasound is combined with live robotic gamma imaging to provide real-time anatomical and nuclear guidance of punch biopsies. The robotic arm holding a gamma camera is equipped with a system for inside-out tracking to directly retrieve the relative position of the US transducer with respect to itself. Based on this, the system cooperatively positions the gamma camera parallel to the US imaging plane selected by the physician for real-time multi-modal visualization. We validate the feasibility of this approach with a dedicated gelatine/agar biopsy phantom and show that lymph nodes separated by at least 10 mm can be distinguished.
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Introduction
The concept of multi-modal imaging is well established in the domain of nuclear medicine, where SPECT/CT, PET/CT, and PET/MR all combine functional with anatomical information. As such, the combination of these modalities is mostly limited to whole-body systems, with notable exceptions being the ClearPEM-Sonic [1] and endoTOFPET-US [2] projects for organ-specific PET and ultrasound (US) imaging. A procedure likely to benefit from a combination of functional and anatomical data is the sentinel lymph node (sLN) biopsy for breast cancer patients, where a radiotracer or colored dye is injected close to the cancer and its spread through the lymphatic system is monitored to identify the first series of nodes that are biopsied for histological assessment. The presence of cancer cells is a key element in staging the disease. Classic radio-guided surgery uses a 1D gamma probe or a 2D gamma camera to identify radioactive-positive lymph nodes in open surgery [3]. Since these techniques provide functional information only, open surgery is required for the
This work was partially funded by the the Bayerische Forschungsstiftung (project RoBildOR). We would like to thank the Department of Nuclear Medicine at Klinikum Rechts der Isar for their kind support with the experiments.
© Springer International Publishing Switzerland 2015 N. Navab et al. (Eds.): MICCAI 2015, Part II, LNCS 9350, pp. 611–618, 2015. DOI: 10.1007/978-3-319-24571-3_73
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Fig. 1. a) View of the full setup and b) close-up of the multimodal image acquisition.
removal of sLNs. The possibility of punch biopsy under multi-modal guidance was recently introduced by combining freehand SPECT with 3D compounded ultrasound [4] and extended to thyroid imaging [5]. The current approach, whilst allowing for a combination of nuclear and anatomical information, suffers from having to conduct two subsequent acquisitions. This not only extends the procedure, but further does not provide any correction of anatomical deformations during the US scan or a real-ti
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