Robots from space lead to one-stop breast cancer diagnosis and treatment

Technology derived from the highly capable robots designed for the International Space Station (ISS) may soon increase access to life-saving surgical techniques to fight breast cancer.

A team of collaborative researchers with the Centre for Surgical Invention and Innovation (CSii) in Canada is working to enhance health care quality and access through the development and commercialization of innovative medical robotic technologies. In particular, an advanced platform is about to enter clinical trials for use in the early diagnosis and treatment of breast cancer.

The main player besides the medical staff is a robot. But not just any robot. This robot's technology was designed for use aboard the ISS by MacDonald, Dettwiler and Associates, Ltd. (MDA) for the Canadian Space Agency (CSA).

Researchers created the Image-Guided Autonomous Robot (IGAR) from a long line of Canadian heavy lifters and maintenance performers for the Space Shuttle and Space Station: Canadarm, Canadarm2 and Dextre. In dealing with breast cancer, IGAR is expected to provide increased access, precision and dexterity, resulting in highly accurate and minimally invasive procedures.

Dr. Mehran Anvari, chief executive officer and scientific director at CSii, said the IGAR platform moves the use of robotics in surgery to a new dimension, allowing the robot to act in an automated fashion after being programmed by a physician.

IGAR is designed to work in combination with an MRI scanner, which is highly sensitive to early detection of suspicious breast lesions before they can turn into a much larger problem. The radiologist uses specially designed software to tag the potential target and tell IGAR what path to take. The software then helps the radiologist make sure he or she is accurately hitting the right area. IGAR has a special tool interface that can be used to define adaptors for any needle-based biopsy device or a wide range of instruments that remove tissue, known in the medical world as needle-based ablation devices.

Anvari explained that the automated robot is capable of placing the biopsy and ablation tools within 1 mm of the lesion in question with a high degree of targeting accuracy, improving sampling, reducing the pain of the procedure, reducing time in the MRI suite and reducing cost as a consequence. He also said that using the robot will allow all radiologists to perform this procedure equally well, regardless of the number of cases per year, and move the site of treatment from operation room to radiology suite for a significant number of patients. The radiologist can operate in the challenging magnetic environment of the MRI, providing access to leading tumour-targeting technology. The robot fits on the patient bed, so it can travel in and out of the MRI opening easily. This in turn simplifies the flow of patients in the department, which can be challenging for many radiologists, and reduces the time it takes to diagnose patients.

Dr. Nathalie Duchesne, co-investigator on the clinical study and breast radiologist at Saint-Sacrement Hospital in Quebec City, Quebec, has been teaching MRI-guided breast biopsy for years and will be performing the first of three clinical trials. She said there are many steps in the procedure that are operator-dependent, and these steps may prevent good sampling of the lesions if not done properly. Duchesne believes IGAR will decrease the time of the exam, ensure good sampling and increase the patient's comfort during the exam. Duchesne and her team think that IGAR will improve sample collection because it will be less operator-dependent, and it will be consistent from one doctor to another, from one patient to the other, and from one lesion to the other.

IGAR removes most of the "manual" aspects of the procedure and reduces user-dependence and the level of training required. This allows for a standard process regardless of experience. An expert will program remotely once the patient is in the MRI suite. A physician will then supervise to make sure the patient is comfortable and there are no complications.

According to Anvari, this technology lays the foundation for a family of telerobotic systems, has the potential to change the way people think about performing these interventions, and ensures that specialized, highly trained doctors are focusing on activities best suited to their training. Anvari believes this technology will improve efficiency in the health care system by streamlining clinical workflow and allowing highly skilled radiologists to extend their care to a wider population through teleoperation.

This robotic technology is not limited to biopsies. Duchesne explained that IGAR is paving the way for the minimally invasive excision and treatment of small tumours that are often found incidentally during pre-op MRI.

The trend toward breast preservation has highlighted the importance of lumpectomies. For tumours that may require this procedure because they are invisible to ultrasound and X-ray mammography, researchers are currently developing the ability for IGAR to deploy a radioactive seed—smaller than a grain of rice—near the area of interest. During surgery, the seed can be located with a detector, allowing the doctor to identify the lesion and remove it with increased accuracy and patient comfort. It is expected that follow-up surgeries also will be greatly reduced.

Whether it be capturing a visiting spacecraft or helping save lives, Canadian-designed robots are lending a hand. Bringing beneficial technologies from the Space Station to the ground will hopefully one day allow us to make historic strides in cancer treatment.

-Reprinted courtesy of NASA

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