SpinoBot: An MRI-Guided Needle Positioning System for Spinal Cellular Therapeutics
The neurodegenerative disease amyotrophic lateral sclerosis (ALS) results in the death of motor neurons in voluntary muscles. There are no cures for ALS and few available treatments. In studies with small animal models, injection of cellular therapeutics into the anterior horn of the spinal cord has been shown to inhibit the progression of ALS. It was hypothesized that spinal injection could be made faster and less invasive with the aid of a robot. The robotic system presented—SpinoBot—uses MRI guidance to position a needle for percutaneous injection into the spinal cord. With four degrees of freedom (DOF) provided by two translation stages and two rotational axes, SpinoBot proved capable of advanced targeting with a mean error of 1.12 mm and standard deviation of 0.97 mm in bench tests, and a mean error of 2.2 mm and standard deviation of 0.85 mm in swine cadaver tests. SpinoBot has shown less than 3% signal-to-noise ratio reduction in 3T MR imaging quality, demonstrating its compliance to the MRI environment. With the aid of SpinoBot, the length of the percutaneous injection procedure is reduced to less than 60 min with 10 min for each additional insertion. Although SpinoBot is designed for ALS treatment, it could potentially be used for other procedures that require precise access to the spine.
KeywordsMRI-guided intervention Spinal injection Stem cell therapy Medical robotics MRI compatible
This study was supported in part by the National Institutes of Health (NIH) Bench-to-Bedside Award, the NIH Center for Interventional Oncology Grant, the National Science Foundation (NSF) I-Corps Team Grant (1617340), NSF REU site program 1359095, the UGA-AU Inter-Institutional Seed Funding, the American Society for Quality Dr. Richard J. Schlesinger Grant, the PHS Grant UL1TR000454 from the Clinical and Translational Science Award Program, and the NIH National Center for Advancing Translational Sciences.
Conflict of interest
The authors declare that they have no conflicts of interest.
- 1.National Institutes of Health. Amyotrophic Lateral Sclerosis (ALS) Information Page. NIH National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Amyotrophic-Lateral-Sclerosis-ALS-Information-Page.
- 2.Human Physiology Academy. An Overview of the Central Nervous System: The Spinal Cord. Human Physiology Academy, 2014. http://humanphysiology.academy/Neurosciences%202015/Chapter%202/A.2.1%20Spinal%20Cord.html.
- 5.Chinzei K., N. Hata, F. A. Jolesz and R. Kikinis. MR compatible surgical assist robot: System integration and preliminary feasibility study. In: International Conference on Medical Image Computing and Computer-Assisted Intervention. New York: Springer, pp. 921–930, 2000.Google Scholar
- 6.Chinzei K., R. Kikinis and F. A. Jolesz. MR compatibility of mechatronic devices: design criteria. In: Medical Image Computing and Computer-Assisted Intervention—MICCAI’99. New York: Springer, pp. 1020–1030, 1999.Google Scholar
- 12.Glass, J. D., N. M. Boulis, K. Johe, S. B. Rutkove, T. Federici, M. Polak, C. Kelly, and E. L. Feldman. Lumbar intraspinal injection of neural stem cells in patients with amyotrophic lateral sclerosis: results of a phase I trial in 12 patients. Regen. Med. 30:1144–1151, 2012.Google Scholar
- 14.Memorang, Inc. Gross Anatomy. Memorang, Inc., 2017. https://www.memorangapp.com/flashcards/56760/Gross+Anatomy/.
- 17.Hoehn, M., E. Kustermann, J. Blunk, D. Wiedermann, T. Trapp, S. Wecker, M. Focking, H. Arnold, J. Hescheler, B. K. Fleischmann, W. Schwindt, and C. Buhrle. Monitoring of implanted stem cell migration in vivo: a highly resolved in vivo magnetic resonance imaging investigation of experimental stroke in rat. Proc. Natl. Acad. Sci. USA 99:16267–16272, 2002.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.International A. ASTM F2554-10. Standard Practice for Measurement of Positional Accuracy of Computer Assisted Surgical Systems, West Conshohocken, PA, 2010.Google Scholar
- 19.International Organization for Standardization. ISO 1101:2017 Geometrical product specifications (GPS)—geometrical tolerancing—tolerances of form, orientation, location and run-out, 2017.Google Scholar
- 20.Krieger, A., I. I. Iordachita, P. Guion, A. K. Singh, A. Kaushal, C. Ménard, P. A. Pinto, K. Camphausen, G. Fichtinger, and L. L. Whitcomb. An MRI-compatible robotic system with hybrid tracking for MRI-guided prostate intervention. IEEE Trans. Biomed. Eng. 58:3049–3060, 2011.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Maderer, J., and M. Feeney. Putting the right face on an assistive robot. Biomed. Saf. Stand. 44:113–114, 2014.Google Scholar
- 25.Mazzini, L., I. Ferrero, V. Luparello, D. Rustichelli, M. Gunetti, K. Mareschi, L. Testa, A. Stecco, R. Tarletti, M. Miglioretti, E. Fava, N. Nasuelli, C. Cisari, M. Massara, R. Vercelli, G. D. Oggioni, A. Carriero, R. Cantello, F. Monaco, and F. Fagioli. Mesenchymal stem cell transplantation in amyotrophic lateral sclerosis: a phase I clinical trial. Exp. Neurol. 223:229–237, 2010.CrossRefPubMedGoogle Scholar
- 30.Pappafotis N., W. Bejgerowski, R. Gullapalli, J. M. Simard, S. K. Gupta and J. P. Desai. Towards design and fabrication of a miniature MRI-compatible robot for applications in neurosurgery. In: ASME 2008 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. American Society of Mechanical Engineers, pp. 747–754, 2008.Google Scholar
- 31.Riley, J., T. Federici, M. Polak, C. Kelly, J. Glass, B. Raore, J. Taub, V. Kesner, E. L. Feldman, and N. M. Boulis. Intraspinal stem cell transplantation in amyotrophic lateral sclerosis: a phase I safety trial, technical note, and lumbar safety outcomes. Neurosurgery 71:405–416, 2012; ((Discussion 416)).CrossRefPubMedGoogle Scholar
- 32.Ringel, F., D. Ingerl, S. Ott, and B. Meyer. Varioguide: a new frameless image guided stereotactic system—accuracy study and clinical assessment. Neurosurgery 64:ons365–ons373, 2009.Google Scholar
- 37.Taguchi, A., T. Soma, H. Tanaka, T. Kanda, H. Nishimura, H. Yoshikawa, Y. Tsukamoto, H. Iso, Y. Fujimori, D. M. Stern, H. Naritomi, and T. Matsuyama. Administration of CD34+ cells after stroke enhances neurogenesis via angiogenesis in a mouse model. J. Clin. Invest. 114:330–338, 2004.CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Tan, N., W.-C. Lin, P. Khoshnoodi, N. H. Asvadi, J. Yoshida, D. J. Margolis, D. S. Lu, H. Wu, K. H. Sung, and D. Y. Lu. In-bore 3-T MR-guided transrectal targeted prostate biopsy: prostate imaging reporting and data system version 2—based diagnostic performance for detection of prostate cancer. Radiology 283:130–139, 2016.CrossRefPubMedGoogle Scholar
- 40.Wolter K., G. Decker and W. Willinek. Transperineal MR-guided stereotactic prostate biopsy utilizing a commercially available anorectal biopsy device. In: RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren©. Georg Thieme Verlag KG, pp. 116–120, 2013.Google Scholar