The New Age of IR: Image-Guided Robotics

Proponents tout robotics' ability to standardize procedures and potentially improve patient outcomes

BY JENNIE MCKEE December 12, 2023

Wood

de Baere

Buijs

Robotic assistance is already making a substantial difference in the field of interventional radiology (IR), from shortening procedure times and minimizing complications to enabling treatment of more complex tumors by expanding the capabilities of a larger number of operators.

Interventional radiologists are using commercial robotics in needle biopsies and needle ablation, as well as endovascular interventions, such as endovascular catheter manipulation, according to Bradford Wood, MD, and the future offers a wealth of possibilities for improving and standardizing many aspects of IR procedures.

“There is an inherent opportunity for robotics to use image guidance to get the right device to the right place in the right sequence,” said Dr. Wood, founding director of the National Institutes of Health (NIH) Center for Interventional Oncology, chief of interventional radiology at the NIH Clinical Center, and adjunct professor of biomedical engineering at the University of Maryland. “That guidance should come in a precise, personalized and iterative fashion, using finely detailed imaging information at the exact time operators need it during the procedure.”

Robotic assistance, “enables exquisite accuracy and can manually perform superior to most inexperienced operators, removing the learning curve, for specific simple tasks, such as getting a needle from point A to point B, as part of an ablation treatment plan” said Dr. Wood, who is the 2023 RSNA Outstanding Researcher. “And it nurtures the promise of standardization and uniformity, whereby, in some instances, the untrained novice can perform as well as the expert, in the case of needle-based tumor ablation, for example.”

ELVIRA BUIJS, MD

Robotics Adds a Level of Accuracy and Efficiency to Procedures

Thierry de Baere, MD, of the Department of Image Guided Therapy at the Gustave Roussy Cancer Center, University of Paris-Sarclay, was the lead author of a study in Cardiovascular and Interventional Radiology on using a robotic system for percutaneous needle insertion during thermal ablation of liver tumors. The study’s results suggest that the robotic assistance in this procedure is both feasible and safe.

“When using robotics, inexperienced as well as very experienced interventional radiologists have the same accuracy, as demonstrated in a pre-clinical study,” Dr. de Baere said, “This opens the door for a faster learning curve.”

Robotic assistance is also valuable because it reduces radiation to physicians, as all CT acquisition is done prior to needle insertion, and needles are inserted without X-ray, Dr. de Baere noted.

Robotics may also aid patients by reducing radiation exposure and giving radiologists rapid access to otherwise inaccessible or difficult to access tumors; however, more research into patient benefits is needed.

“Robotics might also encourage more high-level data creation without the variabilities and ‘noise’ introduced by a variety of operators who are susceptible to human imperfections, such as those involving hand-eye coordination,” Dr. Wood said. “This empowers clinical trials by delivering a uniform standard prescribed treatment, enabling IR to be standardized, similar to a drug or to radiation therapy.”

Multidisciplinary Teams Make Robotics Possible In IR

IR also has a role in complex procedures that may be difficult due to factors such as poor visualization, proximity to non-target organs, small size of lesions or complex vascular anatomies, in the case of tortuous vasculature or vascular disease.

“The combined efforts and advancements in medical engineering, robotics and navigation can make it possible to successfully apply robotics in IR, thereby making improved surgical outcomes a reality,” said Elvira Buijs, MD, a resident in diagnostic radiology at the University of Milan, Italy. Dr. Buijs was senior author on a review in Technology in Cancer Research & Treatment about the current and future applications of robotics in IR.

“The growing use of robotic technology in IR stems from a combined opportunity for radiologists and engineers to push the limits of what is possible during procedures,” Dr. Buijs said. “The use of robotics in other industries is nothing new—their applications and technology can be borrowed and applied in the biomedical industry.”

Possible Advances—and Limitations

Intriguing possibilities exist for combining robotics with virtual and augmented reality technology, as well as AI, noted Dr. Buijs, who also added that MRI is of growing interest for the application of robotics in the IR field.

“Important robotic developments are being made to make in-bore procedures with remote operator access possible,” she said.

As much promise as robotic assistance holds, however, robots have some obvious limitations.

“AI models and robots can both outperform human physicians in specific tasks, according to some metrics, but robots can’t yet fully reproduce the finesse, decision-making skills or complex hand-eye coordination required in many complex, multi-task IR procedures,” Dr. Wood said. “Intelligence and precision cannot replace awareness, judgment and human touch in IR—not just yet at least.”