Needle insertion is a common surgical procedure used in diagnosis and treatment.The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on ne...Needle insertion is a common surgical procedure used in diagnosis and treatment.The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on needle insertion.It is necessary to summarize and analyze the existing results to promote the future development of theories and applications of needle insertion.Thus,a survey of the state of the art of research is presented on algorithms of needle steering techniques,the surgical robots and devices.Based on the analysis of the needle insertion procedure,the concept of needle steering is defined as a kinematics problem,which is to place the needle at the target and avoid the obstacles.The needle steering techniques,including the artificial potential field method and the nonholonomic model,are introduced to control the needles for improving the accuracy.Based on the quasi-static thinking,the virtual spring model and the cantilever-beam model are developed to calculate the amount of needle deflection and generate the needle path.The phantoms instead of the real tissue are used to verify the models mentioned in most of the experimentations.For the desired needle trajectories,the image-guided robotic devices and some novel needles are presented to achieve the needle steering.Finally,the challenges are provided involving the controllability of the long flexible needle and the properties of soft tissue.The results and investigations can be used for further study on the precision and accuracy of needle insertion.展开更多
The force model during needle insertion into soft tissue is important for accurate percutaneous intervention.In this paper,a force model for needle insertion into a tissue- equivalent material is presented and a serie...The force model during needle insertion into soft tissue is important for accurate percutaneous intervention.In this paper,a force model for needle insertion into a tissue- equivalent material is presented and a series of experiments are conducted to acquire data from needle soft- tissue interaction process.In order to build a more accurate insertion force model,the interaction force between a surgical needle and soft tissue is divided into three parts:stiffness force,friction force,and cutting force.The stiffness force is modeled on the basis of contact mechanics model.The friction force model is presented using a modified Winkler' s foundation model.The cutting force is viewed as a constant depending on a given tissue.The proposed models in the paper are established on the basis of the mechanical properties and geometric parameters of the needle and soft tissue.The experimental results illustrate that the force models are capable of predicting the needle-tissue interaction force.The force models of needle insertion can provide real-time haptic feedback for robot-assisted procedures,thereby improving the accuracy and safety of surgery.展开更多
The simulation and planning system(SPS)requires accurate and real-time feedback regarding the deformation of soft tissues during the needle insertion procedure.Traditional mechanical-based models such as the finite el...The simulation and planning system(SPS)requires accurate and real-time feedback regarding the deformation of soft tissues during the needle insertion procedure.Traditional mechanical-based models such as the finite element method(FEM)are widely used to compute the deformations of soft tissue.However,it is difficult for the FEM or other methods to find a balance between an acceptable image fidelity and real-time deformation feedback due to their complex material properties,geometries and interaction mechanisms.In this paper,a Kriging-based method is applied to model the soft tissue deformation to strike a balance between the accuracy and efficiency of deformation feedback.Four combinations of regression and correlation functions are compared regarding their ability to predict the maximum deformations of ten characteristic markers at a fixed insertion depth.The results suggest that a first order regression function with Gaussian correlation functions can best fit the results of the ground truth.The functional response of the Kriging-based method is utilized to model the dynamic deformations of markers at a series of needle insertion depths.The feasibility of the method is verified by investigating the adaptation to step variations.Compared with the ground truth of the finite element(FE)results,the maximum residual is less than 0.92 mm in the Y direction and 0.31 mm in the X direction.The results suggest that the Kriging metamodel provides real-time deformation feedback for a target and an obstacle to a SPS.展开更多
Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematica...Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the “Distance from the Epidermis to the Under-Fascia (DEUF)” and “Distance from the Epidermis to the Iliac Bone (DEB)” of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch’s one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark’s point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter’s point (P < 0.01) at ventrogluteal site on the right side, and Clark’s point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks Hochstetter’s point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.展开更多
A fuzzy control algorithm is adopted to help the needle hit the target more accurately. The experimental setup for the needle insertion is built up to validate the algorithm. How the forces dur- ing the insertion make...A fuzzy control algorithm is adopted to help the needle hit the target more accurately. The experimental setup for the needle insertion is built up to validate the algorithm. How the forces dur- ing the insertion make the needle deflect away from the planned path is given, and the normal meth- od correcting the deflection is obtained accordingly. Because the normal method cannot perform well for correction, a fuzzy controller is established. The input module, output module, fuzzification module, defuzzification module and inference engine for the controller are given respectively accord- ing to the fuzzy theory. Our experimental results show that the fuzzy controlling system presenting in the paper can better eliminate the deflection.展开更多
In order to improve the effectiveness of percutaneous diagnosis and therapies, the needle insertion into the deforming soft and inhomogenous tissue should be accurate. In this study a needle with 6 degrees of freedom ...In order to improve the effectiveness of percutaneous diagnosis and therapies, the needle insertion into the deforming soft and inhomogenous tissue should be accurate. In this study a needle with 6 degrees of freedom force/torque sensor is used to find the relationship between the pathway＇s length and the force. Our experiments show that the method with repeated extraction-insertion cy- cles can make the needle approach the target as much as possible. Meanwhile a method to obtain the appropriaterepeated extraction-insertion cycles is given to drive the needle to execute the repeat- ed cycles efficiently. Experiments and discussions were conducted to preliminarily validate the meth- od.展开更多
High repeatability of needle insertion experiments is essential to the needle-phantom interaction model validation.However,the influential factors governing the accuracy of the phantom and needle deformations have not...High repeatability of needle insertion experiments is essential to the needle-phantom interaction model validation.However,the influential factors governing the accuracy of the phantom and needle deformations have not been systematically studied.In this paper,the impact of influential factors,including phantom characteristic represented by the ratio of DMSO and thawing time(TT),needle properties represented by needle external diameter(NED)and operating factors such as needle insertion velocity(IV),insertion positions(IP)and repeated insertion times(RITs)are analyzed by orthogonal experiment design.The range calculation shows the most sensitive parameters to phantom deformations are RITs,IV and DMSO while the most sensitive parameters to needle deflection are DMSO,TT and NED.By variance analysis,the significant factors on maximum tissue deformation(MTD)are IV,followed by RITs,DMSO and IP.And NED and TT have nearly no significant impact on MTD.The significant sequence on maximum needle deflection(MND)is as follows:DMSO,TT and NED.Results show that,among all impacting factors,phantom deformation is susceptible to both material properties and operative factors while the needle deflection is more susceptible to material properties of the phantom,which can help researchers in related fields to conduct experiments in a more precise manner and better understand the needle-phantom interaction mechanism.展开更多
Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer...Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.展开更多
In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is de...In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.展开更多
OBJECTIVE： It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu（BL23）.METHODS： Twelve dissected specimens were used for studying th...OBJECTIVE： It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu（BL23）.METHODS： Twelve dissected specimens were used for studying the needling pathway of BL23 by perpendicularly inserting the depth-measuring blade of a vernier caliper at BL23. Dimensions of psoas muscle were measured. Correlation studies were conducted. In addition, our samples were grouped by gender and underlying medical conditions for analysis.RESULTS： Half（50%） of the needle insertions successfully punctured psoas muscle. The mean depth of needle insertion to puncture psoas muscle（D_（min）） in the group with short-term underlying medical conditions was 38.0 mm（interquartile range 29.0–51.8 mm）, approximately 6 mm deeper than 32.0（29.3–42.5） mm in the group with long-term health problems（P = 0.041）. The cross-sectional area（CSA） of psoas muscle in the former group was on average approximately 1.5 times that of the latter group（P = 0.04）. When the data were analysed by gender, the thickness of psoas muscle in the male group was 19.0（6.5–24.0） mm compared to 19.5（5.8–34.8） mm in the female group（P = 0.02）. The age in the female group（P = 0.04） and the body length of the total group（P = 0.04） negatively correlated to D_（min）.CONCLUSION： Needle insertion at BL23 might be able to puncture psoas muscle. Differences in the CSA of psoas muscle and D_（min） were observed in groups with short-term and long-term underlying medical conditions.展开更多
In this paper, the background, evolution, basic meaning, clinical application and the detail operating procedures of the differential insertion depth in filiform needle acupuncture were discussed based on the classica...In this paper, the background, evolution, basic meaning, clinical application and the detail operating procedures of the differential insertion depth in filiform needle acupuncture were discussed based on the classical expositions of the Yellow Emperor’s Canon of Medicine. It is believed that the differential insertion depth reflects the basic idea of expelling the evil Qi from the body in the application of traditional acupuncture. Since the site of evil invasion has different shades, the position of evil Qi and correct differentiation has become the operation key points of needle insertion. Apart from this, the Yellow Emperor’s Canon of Medicine has further associated the clinical application of filiform needle insertion depth with the seasonal change of Yin and Yang, the body built of the patients, the nature of the diseases, the heat or cold pathogenic factors of the illness, the excess and deficiency of the patient, and the reinforcing and reducing function of acupuncture. These elaborations have greatly enriched the basic content of acupuncture and laid a systematic theoretical foundation of filiform needle operation. The differential insertion depth in acupuncture has its specific meaning, the emphasis of insertion depth of filiform needle with its differentiated clinical implication exemplifies the perceptual thinking features of traditional acupuncture and typical reveals the uniqueness of Chinese civilization.展开更多
Needle insertion procedures have been gaining in popularity with medical communities and patients over the recent years.Currently,their applications span a wide range of diagnostic and therapeutic procedures and there...Needle insertion procedures have been gaining in popularity with medical communities and patients over the recent years.Currently,their applications span a wide range of diagnostic and therapeutic procedures and there is still a growing tenden?cy toward integrating needle insertion into other procedures and surgeries.Its less invasive nature,which is performed locally on the body,largely explains this growing trend.This results in less intraoperative tissue damage and shorter post-operative recovery time.Many procedures like biopsy,deep brain stimulation,and cancer treatments are done using needles/eatheters.However,despite all the advantages of needle insertion procedures,the inherent complications resulting from them,such as tissue deformation,needle deflection,tissue inhomogeneity,patient variability,and associated uncertainty,can hardly be missed.Therefore,a needle insertion procedure requires that we address promising aspects and associated concerns.Against this backdrop,this paper provides a review of some of the main issues associated with a generic needle insertion procedure.展开更多
Objective： To observe the therapeutic effects of multiple needling with shallow insertion tot simple obesity, and its influence on the chest, waist and hip circumferences, and lipid metabolism. Methods： 20 cases whi...Objective： To observe the therapeutic effects of multiple needling with shallow insertion tot simple obesity, and its influence on the chest, waist and hip circumferences, and lipid metabolism. Methods： 20 cases which match the criteria for diagnosis of simple obesity were treated by multiple needling with shallow insertion. Treatment was given once daily for 20 days as a total therapeutic course. Results： After 20 treatments, the body weight, waistline, and the serum total cholesterol （TC）, the fasting triglyceride （TG） and low-density lipoprotein （LDL） were significantly changed （P〈0.05）. Conclusion： The therapy can provide good theraoeutic effects for simple obesity.展开更多
Hepatocellular carcinoma (HCC) is the second most common malignancy in China.As microwave ablation (MWA) is an effective method for liver cancer,a robotic surgical system with ultrasound-directed was designed to assis...Hepatocellular carcinoma (HCC) is the second most common malignancy in China.As microwave ablation (MWA) is an effective method for liver cancer,a robotic surgical system with ultrasound-directed was designed to assist surgeons on positioning the needles.This robotic system includes a surgical robot with 5 degrees of freedom,a workstation for path-planning and image processing,a conventional 2D ultrasound device,and an electromagnetic (EM) tracking system.Surgery space,clinical operation requirements and optimal mechanical structure are the key factors to be considered in designing a medical robot suitable for use by surgeons.Based on the mechanics of the needle placement robot,we have conducted detailed kinematic analysis,including a combined numerical algorithm and coordinate mapping.Finally,the feasibility of the needle placement robot has been validated by experiment.展开更多
This paper presents an automatic compensation algorithm for needle tip displacement in order to keep the needle tip always fixed at the skin entry point in the process of needle orientation in robot-assisted percutane...This paper presents an automatic compensation algorithm for needle tip displacement in order to keep the needle tip always fixed at the skin entry point in the process of needle orientation in robot-assisted percutaneous surgery. The algorithm, based on a two-degree-of-freedom （2-DOF） robot wrist （not the mechanically constrained remote center of motion （RCM） mechanism） and a 3-DOF robot ann, firstly calculates the needle tip displacement caused by rotational motion of robot wrist in the arm coordinate frame using the robotic forward kinematics, and then inversely compensates for the needle tip displace- ment by real-time Cartesian motion of robot arm. The algorithm achieves the function of the RCM and eliminates many mechanical and virtual constraints caused by the RCM mechanism. Experimental result demonstrates that the needle tip displacement is within 1 inm in the process of needle orientation.展开更多
Lancet needle, having three planes at the tip to generate a sharp lancet point, is the most common needle tip geometry and used for medical procedures. This research presents two five-plane lancet needle designs, the ...Lancet needle, having three planes at the tip to generate a sharp lancet point, is the most common needle tip geometry and used for medical procedures. This research presents two five-plane lancet needle designs, the five-plane lancet needle with two back bevels （FLN-B） and five-plane lancet needle with two front bevels （FLN-F）, to study the effects of two additional bevel planes on the reduction of soft tissue cutting force. Mathematical models to calculate the inclination angle and rake angle along the cutting edges of FLN-B and FLN-F are developed. By using the grinding process, the prototype FLN-B and FLN-F needles are fabricated. And their inclination and rake angles along the cutting edges are investigated and compared to that of regular lancet needle. Needles insertion tests were conducted on soft PVC phantom which mimics the soft tissue. The initial peak insertion force and steady-state cutting force during needle insertion were identified, and the effect of cutting edge on needle soft tissue cutting force was studied. Compared to lancet needle, FLN-B and FLN-F both have higher inclination and rake angles at the tip cutting edge, could reduce the initial peak needle insertion force and tissue cutting forces, and thus can efficiently cut the soft tissue for medical applications.展开更多
Objective: to observe the treatment of shoulder and hand syndrome after apoplexy by combining the penetration of awn needle and rehabilitation treatment. Methods: a total of 40 patients with post-stroke shoulder-hand ...Objective: to observe the treatment of shoulder and hand syndrome after apoplexy by combining the penetration of awn needle and rehabilitation treatment. Methods: a total of 40 patients with post-stroke shoulder-hand syndrome admitted to our hospital from 2019 to 2020 were selected and randomly divided into two groups. One group was the study group and the other group was the control group. Patients in both groups received routine drug therapy and rehabilitation training. Basic drugs were given with anti-inflammatory drugs to relieve pain and control the progression of the disease, and comprehensive rehabilitation was given with exercise therapy and occupational therapy respectively. Acupuncture group was given Mang needle acupuncture treatment on the basis of the control group. Mang needle penetration acupoint selection was Shoulder CondereQuchi, Shoulder Cleansing Patio, Hegu penetration Houxi. During acupuncture, strict disinfection operation was conducted and acupuncture safety was paid attention to. Shoulder and Hand Syndrome Rating Scale (SHSS) and Fogel-Meyer Motor Function Scale (FMA) scores were observed after two courses of treatment and the efficacy was evaluated. Results: compared with before treatment, SHSS score decreased and FMA score increased in all groups. The score of acupuncture group was better than that of control group (P<0.05). The total effective rate of the two groups was 75.8%, among which the acupuncture group was 86.7%, which was better than the control group (66.7%). Conclusion: the combination of needle penetration and rehabilitation treatment has achieved good clinical effects in the treatment of post-apoplexy shoulder and hand syndrome. Compared with the traditional rehabilitation treatment, it can improve the degree of disease of patients, and has obvious effects on the recovery of upper limb function, which is worthy of being widely promoted and applied in clinical practice.展开更多
In this paper, the authors studied the manipulation of ＂dry needling＂, reviewed Chinese ancient and modern literature of acupuncture-moxibustion, and found that ＂dry needling＂ is very similar to triple needling, s...In this paper, the authors studied the manipulation of ＂dry needling＂, reviewed Chinese ancient and modern literature of acupuncture-moxibustion, and found that ＂dry needling＂ is very similar to triple needling, superficial needling, joint valley needling, surround needling, and other traditional Chinese acupuncture- moxibustion manipulations; even if in modern China, before and after the invention of ＂dry needling＂, some unique therapies, such as oblique insertion therapy at Ashi point, sliver needling, Fu＇s subcutaneous needling, and long-round needling, were also invented. It can be seen that ＂dry needling＂ therapy is actually a kind of differentiation of traditional Chinese acupuncture- moxibustion in the international communication. The spread of traditional Chinese acupuncture-moxibustion in the West is the basis for the invention of ＂dry needling＂ therapy, and ＂dry needling＂ therapy develops and enriches traditional Chinese acupuncture-moxibustion.展开更多
He＇s clinical suited acupuncture manipulation is summarized by the famous tradi onal Chinese medical master Prof. HE Pu-ren in his clinical prac ces for almost 70 years,and it is highly favored as ＂flying needle man...He＇s clinical suited acupuncture manipulation is summarized by the famous tradi onal Chinese medical master Prof. HE Pu-ren in his clinical prac ces for almost 70 years,and it is highly favored as ＂flying needle manipula on＂. This manipula on has high requirements on finger strength; it is characterized from techniques for holding needles to needling inser on,and it is painless during needle insertion and the needling responses are rapid; the operations are simple,with high prac cability in clinic,and it can improve working effi ciency and clinical effi cacy.展开更多
基金supported by National Natural Science Foundation of China (Grant Nos. 51165040,50775119)Visiting Scholar Foundation of Key Lab in University of China (Grant No. GZKF-201020)
文摘Needle insertion is a common surgical procedure used in diagnosis and treatment.The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on needle insertion.It is necessary to summarize and analyze the existing results to promote the future development of theories and applications of needle insertion.Thus,a survey of the state of the art of research is presented on algorithms of needle steering techniques,the surgical robots and devices.Based on the analysis of the needle insertion procedure,the concept of needle steering is defined as a kinematics problem,which is to place the needle at the target and avoid the obstacles.The needle steering techniques,including the artificial potential field method and the nonholonomic model,are introduced to control the needles for improving the accuracy.Based on the quasi-static thinking,the virtual spring model and the cantilever-beam model are developed to calculate the amount of needle deflection and generate the needle path.The phantoms instead of the real tissue are used to verify the models mentioned in most of the experimentations.For the desired needle trajectories,the image-guided robotic devices and some novel needles are presented to achieve the needle steering.Finally,the challenges are provided involving the controllability of the long flexible needle and the properties of soft tissue.The results and investigations can be used for further study on the precision and accuracy of needle insertion.
基金Supported by the National Natural Science Foundation of China(No.51175373)New Century Educational Talents Plan of Chinese Education Ministry(No.NCET-10-0625)+1 种基金Key Technology and Development Program of Tianjin Municipal Science and Technology Commission(No.12ZCDZSY10600)Tianjin Key Laboratory of High Speed Cutting&Precision Machining(TUTE)(2013120024001167)
文摘The force model during needle insertion into soft tissue is important for accurate percutaneous intervention.In this paper,a force model for needle insertion into a tissue- equivalent material is presented and a series of experiments are conducted to acquire data from needle soft- tissue interaction process.In order to build a more accurate insertion force model,the interaction force between a surgical needle and soft tissue is divided into three parts:stiffness force,friction force,and cutting force.The stiffness force is modeled on the basis of contact mechanics model.The friction force model is presented using a modified Winkler' s foundation model.The cutting force is viewed as a constant depending on a given tissue.The proposed models in the paper are established on the basis of the mechanical properties and geometric parameters of the needle and soft tissue.The experimental results illustrate that the force models are capable of predicting the needle-tissue interaction force.The force models of needle insertion can provide real-time haptic feedback for robot-assisted procedures,thereby improving the accuracy and safety of surgery.
基金National Major Scientific Research Instrument Development Project of China(Grant No.81827804)Zhejiang Provincial Natural Science Foundation of China(Grant No.LSD19H180004)+1 种基金Science Fund for Creative Group of NSFC(Grant No.51821903)National Natural Science Foundation of China(Grant No.51665049).
文摘The simulation and planning system(SPS)requires accurate and real-time feedback regarding the deformation of soft tissues during the needle insertion procedure.Traditional mechanical-based models such as the finite element method(FEM)are widely used to compute the deformations of soft tissue.However,it is difficult for the FEM or other methods to find a balance between an acceptable image fidelity and real-time deformation feedback due to their complex material properties,geometries and interaction mechanisms.In this paper,a Kriging-based method is applied to model the soft tissue deformation to strike a balance between the accuracy and efficiency of deformation feedback.Four combinations of regression and correlation functions are compared regarding their ability to predict the maximum deformations of ten characteristic markers at a fixed insertion depth.The results suggest that a first order regression function with Gaussian correlation functions can best fit the results of the ground truth.The functional response of the Kriging-based method is utilized to model the dynamic deformations of markers at a series of needle insertion depths.The feasibility of the method is verified by investigating the adaptation to step variations.Compared with the ground truth of the finite element(FE)results,the maximum residual is less than 0.92 mm in the Y direction and 0.31 mm in the X direction.The results suggest that the Kriging metamodel provides real-time deformation feedback for a target and an obstacle to a SPS.
文摘Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the “Distance from the Epidermis to the Under-Fascia (DEUF)” and “Distance from the Epidermis to the Iliac Bone (DEB)” of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch’s one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark’s point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter’s point (P < 0.01) at ventrogluteal site on the right side, and Clark’s point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks Hochstetter’s point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.
基金Supported by the National Natural Science Foundation of Scientific Instruments Basis of Special(51127004)the National Natural Science Foundation of Youth Science Foundation(51105036)
文摘A fuzzy control algorithm is adopted to help the needle hit the target more accurately. The experimental setup for the needle insertion is built up to validate the algorithm. How the forces dur- ing the insertion make the needle deflect away from the planned path is given, and the normal meth- od correcting the deflection is obtained accordingly. Because the normal method cannot perform well for correction, a fuzzy controller is established. The input module, output module, fuzzification module, defuzzification module and inference engine for the controller are given respectively accord- ing to the fuzzy theory. Our experimental results show that the fuzzy controlling system presenting in the paper can better eliminate the deflection.
基金Supported by the National Natural Science Foundation of Scientific Instruments Basis of Special(51127004)the National Natural Science Foundation of Youth Science Foundation(51105036)High-quality CNC Machine-Tool and Basic Manufacturing Equipment Scientific Major Project(2012ZX04010-061)
文摘In order to improve the effectiveness of percutaneous diagnosis and therapies, the needle insertion into the deforming soft and inhomogenous tissue should be accurate. In this study a needle with 6 degrees of freedom force/torque sensor is used to find the relationship between the pathway＇s length and the force. Our experiments show that the method with repeated extraction-insertion cy- cles can make the needle approach the target as much as possible. Meanwhile a method to obtain the appropriaterepeated extraction-insertion cycles is given to drive the needle to execute the repeat- ed cycles efficiently. Experiments and discussions were conducted to preliminarily validate the meth- od.
基金Supported by Zhejiang Provincial Natural Science Foundation of China(Grant No.LSD19H180004)National Major Scientific Research Instrument Development Project of China(Grant No.81827804)and Science Fund for Creative Group of NSFC(Grant No.51821903).
文摘High repeatability of needle insertion experiments is essential to the needle-phantom interaction model validation.However,the influential factors governing the accuracy of the phantom and needle deformations have not been systematically studied.In this paper,the impact of influential factors,including phantom characteristic represented by the ratio of DMSO and thawing time(TT),needle properties represented by needle external diameter(NED)and operating factors such as needle insertion velocity(IV),insertion positions(IP)and repeated insertion times(RITs)are analyzed by orthogonal experiment design.The range calculation shows the most sensitive parameters to phantom deformations are RITs,IV and DMSO while the most sensitive parameters to needle deflection are DMSO,TT and NED.By variance analysis,the significant factors on maximum tissue deformation(MTD)are IV,followed by RITs,DMSO and IP.And NED and TT have nearly no significant impact on MTD.The significant sequence on maximum needle deflection(MND)is as follows:DMSO,TT and NED.Results show that,among all impacting factors,phantom deformation is susceptible to both material properties and operative factors while the needle deflection is more susceptible to material properties of the phantom,which can help researchers in related fields to conduct experiments in a more precise manner and better understand the needle-phantom interaction mechanism.
文摘Risperidone long-acting injectable (RLAI) is approved for the treatment of schizophrenia in many countries. The suggested site is the gluteal muscle with a needle length of two inches (50 mm) in Japan, which is longer than the ordinarily used needle for intramuscular injections. The aim of this study was to determine the optimal needle insertion length for accurate delivery of RLAI procedure among subjects who have normal body mass index (BMI: 18 to 25) and high BMI (>25). Thirty-seven patients with schizophrenia were administered RLAI intramuscularly into the dorsogluteal muscle. The standard procedure required inserting 80% of the two inch needle. By using data collected by ultrasonography, the findings confirmed that the median needle insertion lengths for subjects with normal and high BMI were 39.0 and 45.5 mm, respectively. To deliver RLAI effectively and safely, the authors strongly recommend that a specialized needle be used that is “marked” at the 40 mm point from the tip of the needle to the base. In this way regardless of subcutaneous fat content, the RLAI can be safely delivered into the muscle without causing untoward or side effects.
文摘In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.
文摘OBJECTIVE： It is unknown whether the psoas major muscle, thought to be a key muscle for treatment of lower back pain, can be punctured at Shenshu（BL23）.METHODS： Twelve dissected specimens were used for studying the needling pathway of BL23 by perpendicularly inserting the depth-measuring blade of a vernier caliper at BL23. Dimensions of psoas muscle were measured. Correlation studies were conducted. In addition, our samples were grouped by gender and underlying medical conditions for analysis.RESULTS： Half（50%） of the needle insertions successfully punctured psoas muscle. The mean depth of needle insertion to puncture psoas muscle（D_（min）） in the group with short-term underlying medical conditions was 38.0 mm（interquartile range 29.0–51.8 mm）, approximately 6 mm deeper than 32.0（29.3–42.5） mm in the group with long-term health problems（P = 0.041）. The cross-sectional area（CSA） of psoas muscle in the former group was on average approximately 1.5 times that of the latter group（P = 0.04）. When the data were analysed by gender, the thickness of psoas muscle in the male group was 19.0（6.5–24.0） mm compared to 19.5（5.8–34.8） mm in the female group（P = 0.02）. The age in the female group（P = 0.04） and the body length of the total group（P = 0.04） negatively correlated to D_（min）.CONCLUSION： Needle insertion at BL23 might be able to puncture psoas muscle. Differences in the CSA of psoas muscle and D_（min） were observed in groups with short-term and long-term underlying medical conditions.
文摘In this paper, the background, evolution, basic meaning, clinical application and the detail operating procedures of the differential insertion depth in filiform needle acupuncture were discussed based on the classical expositions of the Yellow Emperor’s Canon of Medicine. It is believed that the differential insertion depth reflects the basic idea of expelling the evil Qi from the body in the application of traditional acupuncture. Since the site of evil invasion has different shades, the position of evil Qi and correct differentiation has become the operation key points of needle insertion. Apart from this, the Yellow Emperor’s Canon of Medicine has further associated the clinical application of filiform needle insertion depth with the seasonal change of Yin and Yang, the body built of the patients, the nature of the diseases, the heat or cold pathogenic factors of the illness, the excess and deficiency of the patient, and the reinforcing and reducing function of acupuncture. These elaborations have greatly enriched the basic content of acupuncture and laid a systematic theoretical foundation of filiform needle operation. The differential insertion depth in acupuncture has its specific meaning, the emphasis of insertion depth of filiform needle with its differentiated clinical implication exemplifies the perceptual thinking features of traditional acupuncture and typical reveals the uniqueness of Chinese civilization.
文摘Needle insertion procedures have been gaining in popularity with medical communities and patients over the recent years.Currently,their applications span a wide range of diagnostic and therapeutic procedures and there is still a growing tenden?cy toward integrating needle insertion into other procedures and surgeries.Its less invasive nature,which is performed locally on the body,largely explains this growing trend.This results in less intraoperative tissue damage and shorter post-operative recovery time.Many procedures like biopsy,deep brain stimulation,and cancer treatments are done using needles/eatheters.However,despite all the advantages of needle insertion procedures,the inherent complications resulting from them,such as tissue deformation,needle deflection,tissue inhomogeneity,patient variability,and associated uncertainty,can hardly be missed.Therefore,a needle insertion procedure requires that we address promising aspects and associated concerns.Against this backdrop,this paper provides a review of some of the main issues associated with a generic needle insertion procedure.
文摘Objective： To observe the therapeutic effects of multiple needling with shallow insertion tot simple obesity, and its influence on the chest, waist and hip circumferences, and lipid metabolism. Methods： 20 cases which match the criteria for diagnosis of simple obesity were treated by multiple needling with shallow insertion. Treatment was given once daily for 20 days as a total therapeutic course. Results： After 20 treatments, the body weight, waistline, and the serum total cholesterol （TC）, the fasting triglyceride （TG） and low-density lipoprotein （LDL） were significantly changed （P〈0.05）. Conclusion： The therapy can provide good theraoeutic effects for simple obesity.
基金supported by the National High-Tech (863) Research and Development Program of China (No.2006AA04Z216)the National Natural Science Foundation of China (No.60875054)
文摘Hepatocellular carcinoma (HCC) is the second most common malignancy in China.As microwave ablation (MWA) is an effective method for liver cancer,a robotic surgical system with ultrasound-directed was designed to assist surgeons on positioning the needles.This robotic system includes a surgical robot with 5 degrees of freedom,a workstation for path-planning and image processing,a conventional 2D ultrasound device,and an electromagnetic (EM) tracking system.Surgery space,clinical operation requirements and optimal mechanical structure are the key factors to be considered in designing a medical robot suitable for use by surgeons.Based on the mechanics of the needle placement robot,we have conducted detailed kinematic analysis,including a combined numerical algorithm and coordinate mapping.Finally,the feasibility of the needle placement robot has been validated by experiment.
文摘This paper presents an automatic compensation algorithm for needle tip displacement in order to keep the needle tip always fixed at the skin entry point in the process of needle orientation in robot-assisted percutaneous surgery. The algorithm, based on a two-degree-of-freedom （2-DOF） robot wrist （not the mechanically constrained remote center of motion （RCM） mechanism） and a 3-DOF robot ann, firstly calculates the needle tip displacement caused by rotational motion of robot wrist in the arm coordinate frame using the robotic forward kinematics, and then inversely compensates for the needle tip displace- ment by real-time Cartesian motion of robot arm. The algorithm achieves the function of the RCM and eliminates many mechanical and virtual constraints caused by the RCM mechanism. Experimental result demonstrates that the needle tip displacement is within 1 inm in the process of needle orientation.
文摘Lancet needle, having three planes at the tip to generate a sharp lancet point, is the most common needle tip geometry and used for medical procedures. This research presents two five-plane lancet needle designs, the five-plane lancet needle with two back bevels （FLN-B） and five-plane lancet needle with two front bevels （FLN-F）, to study the effects of two additional bevel planes on the reduction of soft tissue cutting force. Mathematical models to calculate the inclination angle and rake angle along the cutting edges of FLN-B and FLN-F are developed. By using the grinding process, the prototype FLN-B and FLN-F needles are fabricated. And their inclination and rake angles along the cutting edges are investigated and compared to that of regular lancet needle. Needles insertion tests were conducted on soft PVC phantom which mimics the soft tissue. The initial peak insertion force and steady-state cutting force during needle insertion were identified, and the effect of cutting edge on needle soft tissue cutting force was studied. Compared to lancet needle, FLN-B and FLN-F both have higher inclination and rake angles at the tip cutting edge, could reduce the initial peak needle insertion force and tissue cutting forces, and thus can efficiently cut the soft tissue for medical applications.
文摘Objective: to observe the treatment of shoulder and hand syndrome after apoplexy by combining the penetration of awn needle and rehabilitation treatment. Methods: a total of 40 patients with post-stroke shoulder-hand syndrome admitted to our hospital from 2019 to 2020 were selected and randomly divided into two groups. One group was the study group and the other group was the control group. Patients in both groups received routine drug therapy and rehabilitation training. Basic drugs were given with anti-inflammatory drugs to relieve pain and control the progression of the disease, and comprehensive rehabilitation was given with exercise therapy and occupational therapy respectively. Acupuncture group was given Mang needle acupuncture treatment on the basis of the control group. Mang needle penetration acupoint selection was Shoulder CondereQuchi, Shoulder Cleansing Patio, Hegu penetration Houxi. During acupuncture, strict disinfection operation was conducted and acupuncture safety was paid attention to. Shoulder and Hand Syndrome Rating Scale (SHSS) and Fogel-Meyer Motor Function Scale (FMA) scores were observed after two courses of treatment and the efficacy was evaluated. Results: compared with before treatment, SHSS score decreased and FMA score increased in all groups. The score of acupuncture group was better than that of control group (P<0.05). The total effective rate of the two groups was 75.8%, among which the acupuncture group was 86.7%, which was better than the control group (66.7%). Conclusion: the combination of needle penetration and rehabilitation treatment has achieved good clinical effects in the treatment of post-apoplexy shoulder and hand syndrome. Compared with the traditional rehabilitation treatment, it can improve the degree of disease of patients, and has obvious effects on the recovery of upper limb function, which is worthy of being widely promoted and applied in clinical practice.
文摘In this paper, the authors studied the manipulation of ＂dry needling＂, reviewed Chinese ancient and modern literature of acupuncture-moxibustion, and found that ＂dry needling＂ is very similar to triple needling, superficial needling, joint valley needling, surround needling, and other traditional Chinese acupuncture- moxibustion manipulations; even if in modern China, before and after the invention of ＂dry needling＂, some unique therapies, such as oblique insertion therapy at Ashi point, sliver needling, Fu＇s subcutaneous needling, and long-round needling, were also invented. It can be seen that ＂dry needling＂ therapy is actually a kind of differentiation of traditional Chinese acupuncture- moxibustion in the international communication. The spread of traditional Chinese acupuncture-moxibustion in the West is the basis for the invention of ＂dry needling＂ therapy, and ＂dry needling＂ therapy develops and enriches traditional Chinese acupuncture-moxibustion.
文摘He＇s clinical suited acupuncture manipulation is summarized by the famous tradi onal Chinese medical master Prof. HE Pu-ren in his clinical prac ces for almost 70 years,and it is highly favored as ＂flying needle manipula on＂. This manipula on has high requirements on finger strength; it is characterized from techniques for holding needles to needling inser on,and it is painless during needle insertion and the needling responses are rapid; the operations are simple,with high prac cability in clinic,and it can improve working effi ciency and clinical effi cacy.
