Running head: PROJECT REPORT 1

Review : A Robot-Assisted Surgical System Using a Force-Image Control Method for

pedicle Screw Insertion

Shivang Patel - 115504950

University of Maryland, College Park
PROJECT REPORT 2

Abstract

This paper contains the review of the paper "A Robot-Assisted Surgical System Using a
Force-Image Control Method for pedicle Screw Insertion". Paper will be explaining the
terms and methodology of the robotics system. And also evalute the main idea of the
paper.
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Review : A Robot-Assisted Surgical System Using a Force-Image Control Method for

pedicle Screw Insertion

Contents

Abstract 2

Review : A Robot-Assisted Surgical System Using a Force-Image Control Method for

pedicle Screw Insertion 3

Introduction 4

Methodology 4
Robotic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Algorithm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Practical Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Experiment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Force analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Results 8

Conclusion 8

References 10
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List of Figures

1 Image containing the planned insertion and actual (Tian et al., 2014) . . . . 11
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Introduction

The paper titled "A Robot-Assisted Surgical System Using a Force-Image Control
Method for pedicle Screw Insertion" is mainly about implementing safety on robot assisted
surgery. Here surgery is specifically fixing pedicle screws in the pedicles of the vertebra.
This paper is using a force-image approach for control system for safety. At the begining
they explain the evolution of the automatic spinal robot. They have explain various feature
of the robot and later they explain about their state recognising algorithm. After that they
explain the whole procedure of the spinal surgery with this robot and they have analyze
force signals to evalute the safety of the system.

Methodology

This Spinal Robot is a 6-DOF manipulator equiped with force/torque sensor. The
system, including manipulator, consists of optical tracking, navigation and planning
system. The system uses ARCADIS Orbic 3D’s 3D images of sagittal, coronal and axial
planes for preparing navigation of robot. Sagittal plane is a plane parallel to the sagittal
sature which will divides the body into left and right, and Coronal plane divides the body
into ventral and dorsal portions. These images are then compare to the real time images of
the patient for precise trajectory planning.
The movements of the spinal robot in the space should be precise. For that, they have
used infrared tracking system which consists of camera (Polaris fron NDI), homogeneous
markers and a pointer. homogeneous markers are attached to the end effector and also to
the vertebra. Pointer are point coordinate space for navigation. Tracker or camera will
monitor or control the end effector using the attacked markers and will guide to the precise
position on the human vertebra and it can be precise done with the help of the markers
which are attached to the vertebra. They have obtain precise positioning my calibration.
First they define some fiducial points on the image which is obtain by the planning system.
Then comapare the distance to the optical tracking system. By repeating this operation,
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real coordinates are synchronize with the system. From markers, the orientation of the end
effector can be obtain (Kim, Chung, Yi, & Kim, 2010; Nottmeier & Crosby, 2007).
In addition to the above methods, they have also used Model Predict Control (MPC)
as compensation strategy. This control method rely on dynamic component of the process
an this method cannot be implement on simple system. Mostly simple systems are solved
by various PID mehods. Whereas MPC mostly predicts the change in the dependent
variable of the modeled system which is due to change in the independent variables. In this
case, it predicts the the movement and it is used as compensation input for the control
system (Lee, Natarajan, & Lee, 2001).

Robotic System

Their robotic system consist of 6-DOF robotic arm and 1-DOF end effector which is
of drilling. The drilling tool is used for drilling screw paths. The 6-DOF arm is equiped
with force/torque sensor which is used to measure the force signals while drilling process.
The data acquision of this robotic system consists of DAQ, buffer of length 50 etc. The
force signals are transfer through DAQ with sampling rate of 1 KHz. Through the DAQ it
goes to buffer and from buffer they were sent to dynamic link library where force signals
are collected and analysed further.

Algorithm

They call their Algorithm as "State Recognition Algorithm". This algorithm has
three steps, data pretreatment; force feature extraction; state recognition. In data
pretreatment stage, force signals are sample as short time average values and their
difference can be consider as the feature of the force. Feature as in the positive or negative
force, which will use to recognize the nature of the force. Force feature extraction has
unique feature to extract fundamental forces from the hybrid force. After this state
recognition algorithm is presented on the threshold values.
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They have studied the behavior of the force in varous layer of the tissues. For
example they notice that force signals in cortical tissue and cancellous tissue present
different characteristics. When the drill penetrate the second cortical penetration, will
cause sevear injuries. So, they decided to make the drill stop when it penetrates this level.
This concludes that they are using image infromation along with the force data to prevent
any potential injuries to the patient.

Practical Flow

Here for this paper, practical flow will be surgerical flow. In this section I will discuss
the surgical planning made by surgeons for this machine. They have divided this step in to
stages. First will be pre-operating stage, fixing homogeneous markers onto the vertebra of
the patient. After scanning the 3D image with the C-Arm. The images obtain using
C-Arm will be used to obtain the real coordinate system, in other words, callibration of the
3D image with the actual 3D point system. This is just the calibration of the robotic arm.
After that the surgeon will drag the drill tool bit towards the starting position of the
operation. After switching the robot into automatic control mode the robot will be ready
with path planning and it waits for the order of the superiors. After checking the
consitions, robot starts to drill into vertebra. The signals will be recorded till it reaches its
last stage. If in between the force signals were recorded abnormal, drilling will be
automatically stopped. After this drilling the path, surgeon will insert screw, clean the
wound, and that would be the end of the operation according to the authors.

Experiment

Authors have experimented this surgery on the sheep with the permission of the
slaughterhouse. They have demonstrated their system to evaluate their accuracy. They
have perform the experiment on 8 lumbar spines of sheep with the institutional Animal
Care and Pecking university approval.
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The weight of the sheep was 58-73 kg and they were roughly 2-3 years old. The
screws which were used here were of size 4.5mm diameter and 40mm long. They have
roughly penetrated 32 levels, randomly between 2-5 cortial breach per sheep. The
operation were perform according to the practical flow.

Evaluation

They have evaluated the experiment with the results from CT scan. They claim that
two radiologist perform the blind evalution of the screw position. They have not mention
any specific name of the radiologist. They have measure every cortial breach in millimeter
in each direction which was the idea of Gertzhein and Robbins (Kim et al., 2010;
Pechlivanis et al., 2009; Şarlak, Buluç, Sarısoy, Memişoğlu, & Tosun, 2008). They also
measure the angular error of the planned one and the actual one.

Force analysis

They have analysed the sampled force signals to judge whether the robot
automatically detected the drilling state and acted upon it. For that they looked into the
recorded force signals and compare the states with the action of the robot. If robot had
perform according to the force state then the robot can be said to be accurate (?).

Safety

Safety for this experiment is to able to detect the penetratred level. Because every
time the level might be different but robot needs to detect each penetration. So to conform
that robot applied the safety protocol they check the inner canal or outer cortex bone.
This will also prove wheather or not robot can detect the force abnormality.

Results

They observerd through CT images that the pedicle screw’s placement was accurate
as there were no damage or perforation of the the spinal cord or any misplacement. And
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they claim that all the placed screws were in good position accourding to Gertzhein and
Robbins classification.
Gertzhein and Robbins classification is set of data in which there is some specific
places are classified concerning the placement of the pedicle screw.
In further evaluation they found out that there was some minor deviation between
planned and actual placement of the screws entry angles. These difference can be seen from
lateral as well as axial view.
From the Figure 1, it can be clearly seen the planned position of the pedicle screw
and the actual position. There is minor deviation.
They divided the curve in four parts. The initial stage is the first cortial state; the
cancellous state; second cortial stage; potential second cortial stage. Now if the drill
crossed the fourth stage that means it has injured the patient. So for safetly of the patient
robot should detect all the defined stages and should stop before penetrating the fouth
stage. In their evalution, in all the 32 opertaion robot has never cross the fourth stage. So
this proves the reliablity of the robot in terms of safety.
According to their report, when robot chose the wrong trejectory it stops right after
penetrating the second stage due to abnormal force signals.

Conclusion

Their main concern is adding safety in their already owned robot. To increase safety,
they develop this Force-Image control system. There are some advantages and disadvantes
of using such system in spinal robot.
This system can easily recognize the drilling stages with the state recognition
method. It can also extract the drilling state or feature from the data algorithm. This
feature helps directly in maintaing safety of the patient. Since safety is the major concern
of the medical robotics, they have successfull develop safe system.
Disadvantage of this system can be the misplacement of the pedicle screws. Since
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there wasn’t any issue during thoes 32 operation except the minor misplacemement. Even
though it cannot be neglected, these minor errors can someday leads to a major one.
Advance techniques to be develop to mitigate the issues.
As their all the 32 experiments was a success, they have tried to place the screw at
wrong position just to traverse aberrently. The drill stop after the second peneration as it
has face abnormal force signals.
But there are some issues which they have to deal with. They have found out that
sometimes robot cannot detect the third stage penetration without some X-Ray input.
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References

Kim, S., Chung, J., Yi, B.-J., & Kim, Y. S. (2010). An assistive image-guided surgical
robot system using o-arm fluoroscopy for pedicle screw insertion: preliminary and
cadaveric study. Neurosurgery, 67 (6), 1757–1767.
Lee, J. H., Natarajan, S., & Lee, K. S. (2001). A model-based predictive control approach
to repetitive control of continuous processes with periodic operations. Journal of
Process Control, 11 (2), 195–207.
Nottmeier, E. W., & Crosby, T. L. (2007). Timing of paired points and surface matching
registration in three-dimensional (3d) image-guided spinal surgery. Clinical Spine
Surgery, 20 (4), 268–270.
Pechlivanis, I., Kiriyanthan, G., Engelhardt, M., Scholz, M., Lücke, S., Harders, A., &
Schmieder, K. (2009). Percutaneous placement of pedicle screws in the lumbar spine
using a bone mounted miniature robotic system: first experiences and accuracy of
screw placement. Spine, 34 (4), 392–398.
Şarlak, A. Y., Buluç, L., Sarısoy, H. T., Memişoğlu, K., & Tosun, B. (2008). Placement of
pedicle screws in thoracic idiopathic scoliosis: a magnetic resonance imaging analysis
of screw placement relative to structures at risk. European Spine Journal, 17 (5),
657–662.
Tian, W., Han, X., Liu, B., Liu, Y., Hu, Y., Han, X., . . . Jin, H. (2014). A robot-assisted
surgical system using a force-image control method for pedicle screw insertion. PloS
one, 9 (1), e86346.
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Figure 1 . Image containing the planned insertion and actual (Tian et al., 2014)