Abstract:

Magnetic Resonance Imaging (MRI) is now a widely used modality for providing multimodal, high-quality soft tissue contrast images with good spatiotemporal resolution but without subjecting patients to ionizing radiation. In addition to its diagnostic potential, its future theranostic value lies in its ability to provide MRI-guided robot intervention with combined structural and functional mapping, as well as integrated instrument localization, target recognition, and in situ, in vivo monitoring of the therapeutic efficacy. Areas of current applications include neurosurgery, breast biopsy, cardiovascular intervention, prostate biopsy and radiotherapy. Emerging applications in targeted drug delivery and MRI-guided chemoembolization are also being pursued. Whilst promising progress has been made in recent years, there are still significant basic science research and engineering challenges. This paper provides a comprehensive review of the current state-of-the-art in MRI-guided robot intervention and allied technologies in actuation, sensing, new materials, interventional instruments, and interactive/real-time MRI. Potential future research directions and new clinical developments are also discussed.

Fig. 1 A detailed analysis of the currently developed MRI-guided robot intervention systems in different clinical specialties. Twenty more advanced surgical robot systems are highlighted as individual icons, which are distributed by DoF (horizontal axis) and accuracy (vertical axis). The proportion of the number of MRI-guided robot intervention systems, based on 95 independent systems, in eight clinical specialties are shown on two sides of the figure. Out of the systems developed about 24% are for prostate surgery, mostly for biopsy; 14% are for brain surgery, typical applications including tumor removal, Laser Interstitial Thermo Therapy (LITT), stereotaxic and microsurgery, DBS; 14% for breast surgery, including biopsy; 9% for artery intervention, including Percutaneous Coronary Intervention (PCI), electrophysiology, Transcatheter Aortic Valve Replacement (TAVR); 7% for liver surgery, application including laser ablation; 5% for MRgFUS and 4% for spinal cord surgery, including cannula alignment and cellular therapeutics.

Fig. 2 Exemplar MRI-guided robotic systems for various clinical applications, showing example systems for: neuroArm for brain surgery developed by University of Calgary; MrBot for prostate biopsy developed by Johns Hopkins University; Imperial College London’s system for artery intervention; ROBITOM II for breast surgery developed by Friedrich Schiller University Jena; The University of Hong Kong’s system for transoral surgery; Johns Hopkins University’s system for spinal cord treatment; Imperial College London’s system for liver ablation and Cyprus University of Technology’s system for MRgFUS.

https://doi.org/10.1007/s44258-023-00003-1