Certainly, it's a large understatement to describe the standard lung cancer biopsy as inconvenient, not particularly patient-friendly. Extremely unpleasant doesn't even tell the whole story.

The thought of having a needle stuck in your lung is scary enough. Then having to be re-positioned so that the needle can be re-inserted numerous times over the course of a couple of hours is just medical piling on. And in a typical lung biopsy, this is the norm. Currently, lung biopsies and ablations are extremely tedious, involving multiple static CT images and repeated manual needle/probe manipulations.

But now a group of enterprising graduate students at Massachusetts Institute of Technology (MIT; Cambridge, Massachusetts) have developed a product — the Robopsy — to make the process more efficient and less time-consuming and so much easier on the patient.

Robopsy is a collaborative development by the students and radiologist Rajiv Gupta, of Massachusetts General Hospital (Boston), and the product recently was awarded the MIT $100,000 Entrepreneurship Competition, its inventors carrying away a $100,000 prize.

Robopsy is a remote, telerobotic needle insertion system that assists radiologists in targeting potentially cancerous lesions during computed tomography (CT) image-guided tumor biopsy and ablation procedures. By enabling needle insertion remotely, Robopsy allows doctors to perform procedures while simultaneously imaging the patient "live," thus reducing the number of needle insertions and scans required, and thereby reducing procedure time and patient radiation dose.

All of this results in increasing the accuracy of the procedure and facilitating earlier detection and treatment by enabling the targeting of smaller lesions than would be possible by hand and without live imaging, according to the inventors.

John Harthorne, an MBA student and one of the systems' developers, told Medical Device Daily that Robopsy "consists of a disposable unit and a durable unit. The disposable unit overall — designed to improve the lung biopsy procedure — makes it more accurate, makes it faster and reduces risk of complications."

For comparison, he goes on to describe the current circuitous practice:

"Say you have a suspicious lesion on your lung — they have scanned you with a CT scanner, and they have identified a location on your lung that looks suspicious [so] they want to take a tissue sample to run tests on it. The current procedure would have [the patient] placed in the CT scanner, and identified very precisely with sub-millimeter accuracy the precise location of the lesion. Then they would wheel you out of the machine and place a needle into your chest — manually, approximately targeting that location.

"The doctor leaves the room, goes to the radiation-shielded control room, rescans you with the needle in your chest to determine how closely they've targeted it. Then they wheel you back out, manipulate the needle to get it a little bit closer, put you back in and rescan — and so on."

Not pleasant.

Robopsy thus aims to reduce the number of these activities, making detection more efficient and, hopefully, faster — especially important for lung cancer, which often spreads more rapidly than other cancers. And unless treated at the earliest stages, the fatality rate is extremely high. Just as important for the patient, the system could improve patient care by reducing potential complications caused by repeated invasions of the chest cavity via the repeated needle insertions.

Hospital administrators and insurance companies also will appreciate Robopsy because it reduces procedure time, thus increasing throughput on expensive imaging equipment and decreasing the cost of each procedure.

Nevan Hanumara, who along with fellow engineering student Conor Walsh invented Robopsy, further explained the improved Robopsy process for MDD: "We want to replicate the doctor's motions, but do them better with more precision. There are two motors that correspond to the two angles of the needle — toward the head and feet and left and right. The other pair of motors drives the needle into the patient, and then grabs the needle. So, we have done the motions that a doctor would do — tilt, grip and release."

Harthorne further explained: "The unit is a plastic robot that is affixed to the patient's chest, it has a cable running into a control unit and to a laptop. The doctor can sit in the control room and manipulate the robot from the radiation-shielded control room live while the scanner is scanning the patient. The robot's two motors can grasp a needle and insert it through the ribcage, targeting the lesion much more precisely than can be done by hand.

"And because it's done in live real-time with the scan, it's a much faster procedure, because you don't have to constantly wheel the patient out, rescan, wheel him out, rescan — you can do it in one shot. In a normal procedure the doctor can't manipulate the needle in real time because of the radiation effect [of the CT scan]."

As for the future of Robopsy, Walsh said that the device is in a beta testing stage at Massachusetts General, and, "going forward, the device needs one more run of design with some new features and refinements made to it. We plan on doing some extensive testing on live pigs to test the accuracy of the device. Over the next year, we hope to submit for FDA approval."

"We're not sure exactly how much better [Robopsy] will be," Harthorne said, in terms of the exact amount of improvement. But he goes on to suggest that any small improvement over the standard procedure will be huge.

"With the current procedure, there is a 28% chance of a partial lung collapse, and 3% of the time there is a total lung collapse," he said. So we believe we can significantly reduce these complications."

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