The American Cancer Society estimates that 182,460 women will be diagnosed with breast cancer and that 40,480 women will die of breast cancer in the United States alone in 2008. One in 8 women born today is likely to be diagnosed with breast cancer during their lifetime. Although these statistics are discouraging, positive trends are evident as a result of innovations in diagnosis and treatment over the past decade. Recent, large scale studies reported in The Lancet and The New England of Journal of Medicine demonstrate the value of MRI as an effective tool in the diagnosis of breast cancer. Hence, coupling diagnosis with MRI based biopsy (Bx) will lead to better delineation of the tumor margin. For breast cancer treatment, radiofrequency ablation (RFA) has emerged as a promising approach for early stage breast cancer with maximum effectiveness and conservation of healthy breast tissue without full surgical intervention. While Ultrasound (US) and Computed tomography (CT) is the imaging modality for RFA, they are not without their drawbacks. In US, there is limitation on the precision with which a needle placement can be performed and the image distortion due to the formation of microbubbles during RFA obscures the visualization of the tumor. CT lacks the ability of providing soft tissue contrast as good as MRI and also exposes the patients to radiation dose. MRI on the other hand provides excellent soft-tissue contrast, no ionizing radiation, and accurate thermographic maps at the ablation site. Although the utility of RFA has been demonstrated in treating several types of lesion, the recurrence rate of tumors has not been as low as one would desire (8-47%). The recurrence of cancer after RFA or misdiagnosis in a breast biopsy using US, CT, or MRI could be a result of planning the trajectory towards the tumor based on images obtained earlier and not under continuous MRI guidance. Although a subjective evaluation is performed after the placement of the needle, even small errors in the trajectory could lead to sub- optimal results for biopsy and RFA. Hence, we propose a novel robotic approach with haptic feedback under continuous MRI with frontal access (from the head of the magnet bore) and oblique angle needle driving capability for both breast biopsy and RF ablation in a manner that minimizes sampling errors during biopsy and delivers optimal therapy during RF ablation. The proposed system will be a significant improvement of the current MRI 'guided'lateral (left or right side) approach with limited angle needle trajectory. At the very fundamental level, this project seeks to provide physicians with: 1) the ability to perform biopsy and accurate delivery of RFA probe under continuous MRI and 2) a teleoperated robotic system with haptic feedback capability to help the physician guide the biopsy and RFA needle with frontal access and oblique angle needle driving capability, enabling a wider access angle to various regions of the breast. To accomplish this, we have assembled an excellent team of engineers and clinicians from the University Of Maryland School Of Medicine and the NIH for this extremely important health-care project.
The American Cancer Society estimates that 182,460 women will be diagnosed with breast cancer and that 40,480 women will die of breast cancer in the United States alone in 2008. The purpose of this project is to develop a novel robotic system that will work under continuous magnetic resonance imaging for both breast biopsy (Bx) and radiofrequency ablation (RFA) of breast tumor.
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