Interventional News: Rise of the Robots
By Keith Loria
Radiology Today
Vol. 22 No. 5 P. 26

Companies introduce robotic tech to improve radiology.

The use of robots in health care is becoming more prevalent as technology advances and price points for robotics decrease to somewhat affordable numbers. This year, several companies have introduced robotic systems that radiologists are keeping an eye on.

For example, the XACT ACE Robot is a new system created by Israel-based XACT Robotics. It is designed to help interventional radiologists access small and hard-to-reach targets in the body earlier and on the first attempt. This can help patients get an earlier diagnosis and treatment. Chen Levin, CEO of XACT Robotics, explains that the robot is the size of an iPad, yet can reach small targets in the human body with 1/8-inch average accuracy.

“We combined image guidance and navigation for interventional procedures, coupled with insertion and steering done by a robot,” Levin says. “For the first time, we are separating the planning from the actual insertion and steering of the instrument to target, which is performed by the robot hands-free.” This creates a clear separation between the intellectual skills required to plan the procedure and the technical skills required to perform the insertion of an instrument to target in soft tissue.

To perform a procedure, a radiologist straps the ACE Robot onto the patient and identifies the entry point and path the needle should follow to the target. The robot inserts the needle and reaches the target, even if it moves during the procedure, which Levin explains, happens often when a needle is inserted or when a patient breathes or moves. Since the robot can complete the job on first insertion, it becomes less likely that a patient will need to be stuck multiple times, which is always a risk with small targets in hard-to-reach locations.

“The interventional radiology space is the first market we are addressing,” Levin says. “An interventional radiologist uses imaging systems to visualize what is inside the body, and then they use various needle-type instruments at the different targets to perform treatments for a variety of procedures.”

These procedures are often done with ultrasound, X-ray, MRI, or CT. The XACT ACE Robot system works with CT and, once the imaging is done, the visualization is high quality.

 “Even a 1-mm nodule can be visible on an MRI, but accessing that region is a whole issue,” Levin says. “In this space, not much has changed over the past 30 years. It’s still based on the technical skills of the physician.” In soft tissue procedures, such as in the liver, kidney, or lungs, organs are moving because the patient is breathing, making it extremely difficult to hit a specific target.

Lahey Hospital & Medical Center outside of Boston is the first to utilize XACT ACE Robot in the United States. “When a patient comes in, they get scanned, and when they start the procedure, the physician will use our system to plan it so that the image is transferred from the CT scanner into our system and the physician can view those 3D images,” Levin says. “The physician will tell the system where the target is, where the entry point is, and where they would like the robot to start and stop, so another scan can be performed for verification.”

The robot is then strapped to the patient, the needle is attached through an adapter, and the physician enables the robot to enact the procedure by using a foot pedal. If the system recognizes that the needle has deviated from the planned trajectory after it has been inserted, the robot will automatically steer back to the proper trajectory.

By the end of June, Levin expects hundreds of procedures to have been done, and the company hopes to have five centers of excellence established as early adopters in the year ahead.

Spinal Navigation
Since the introduction of robotics in spine surgery, questions of economics and efficiency have hindered widespread adoption of the technology, but that seems to be changing, as well. Fusion Robotics, based in Boulder, Colorado, recently received FDA clearance for its 3D imaging–compatible navigation and robotic targeting system for spine surgery in the United States. Brad Clayton, Fusion Robotics’ CEO, says that by offering greater procedural efficiency with significantly less expense, the robotic system addresses some of the key limitations of current spinal navigation and robotics systems.

“We appreciate the partnership developed with FDA to rigorously validate safety and accuracy,” Clayton said in a prepared statement. “Next, we look forward to partnering with clinicians and hospitals to increase efficiency, reduce cost, and broadly expand the application of robotics to treat patients.”

Kevin Foley, MD, CMO of Fusion Robotics, says that the rapid development of the company’s fluoroscopy-integrated system will make robotics available to a greater number of surgeons and easier to use in their practices.

In March, Foley successfully used the system at Baptist Memorial Hospital in Memphis, Tennessee, in what was the first single-level, minimally invasive transforaminal lumbar interbody fusion, which included the placement of pedicle screw fixation.

“We’re thrilled to be the first hospital in the world to use this newly available technology,” Kimberly Hallum-Stewart, Baptist Memorial’s system administrator for neurosciences, says. “With the surgical accuracy and price point of this technology, it is easy to see that robotic technology will now become more available to both large medical centers, as well as smaller regional hospitals—an opportunity that has not been available until now.”

Fusion Robotics plans for a wider rollout of its system later in 2021.

— Keith Loria is a freelance writer based in Oakton, Virginia. He is a frequent contributor to Radiology Today.