The goal of this Bioengineering Research Grant proposal is to develop and evaluate a patient-mounted MRI-compatible robot that allows accurate needle placement for injections around nerves to treat pain in adult and pediatric patients. This body-mounted robot will completely eliminate radiation exposure during perineural injection procedures by transitioning from fluoroscopic and computed tomography (CT) guidance to the MRI environment. MRI provides unmatched visualization of the targeted nerves and delivery of the locally injected medications around these nerves without the need of an artificial contrast agent. The robot will enable needle tip and target visualization under MRI in real-time through an integrated imaging coil, built-in fiducials for image registration, and active needle insertion/rotation.
Our specific aims are to: 1. Develop a clinical grade, patient-mounted MRI-compatible robot for pain injections in the lower back and pelvis. The robot will be strapped on the area of interest and will precisely orient a needle guide for injection in the scanner bore. The robot will include active needle driving to enable real-time imaging of the path and needle tip as the needle is advanced via remote control. 2. Develop an MRI imaging coil and registration fiducials for the robotic system that are integrated into the robot mount. This approach will enable high resolution imaging of the anatomy of interest and co-registration of the imaging and robotic coordinate systems. 3. Develop a trajectory planning workstation for image-to-robot registration, selection of the target location, and trajectory verification. 4. Integrate the robot with the planning workstation and evaluate the system in the MRI environment using phantoms and cadavers. If any issues are found, they will be corrected before clinical trials begin. 5. Complete clinical feasibility studies, beginning with an adult study at Johns Hopkins. Once the adult study shows the robot system is feasible and safe, we will move to a pediatric study at Children's National.
Pain management is an important clinical problem in both adult and pediatric patients. In this proposal, we will develop and evaluate an MRI-compatible body-mounted robot for accurate needle placement for injections around nerves to treat pain. We hope this will lead to more accurate pain injections and better pain management.