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Handheld surgical robotic might help stem deadly blood loss

Matt Johnson (proper) and Laura Brattain (left) take a look at a brand new medical system on a synthetic mannequin of human tissue and blood vessels. The system helps customers to insert a needle and guidewire rapidly and precisely right into a vessel, a vital first step to halting speedy blood loss. Picture: Nicole Fandel.

By Anne McGovern | MIT Lincoln Laboratory

After a traumatic accident, there’s a small window of time when medical professionals can apply lifesaving remedy to victims with extreme inner bleeding. Delivering the sort of care is advanced, and key interventions require inserting a needle and catheter right into a central blood vessel, by means of which fluids, drugs, or different aids could be given. First responders, equivalent to ambulance emergency medical technicians, aren’t skilled to carry out this process, so remedy can solely be given after the sufferer is transported to a hospital. In some situations, by the point the sufferer arrives to obtain care, it might already be too late.

A workforce of researchers at MIT Lincoln Laboratory, led by Laura Brattain and Brian Telfer from the Human Well being and Efficiency Techniques Group, along with physicians from the Middle for Ultrasound Analysis and Translation (CURT) at Massachusetts Common Hospital, led by Anthony Samir, have developed an answer to this downside. The Synthetic Intelligence–Guided Ultrasound Intervention Machine (AI-GUIDE) is a handheld platform expertise that has the potential to assist personnel with easy coaching to rapidly set up a catheter into a standard femoral vessel, enabling speedy remedy on the level of harm.

“Simplistically, it’s like a very smart stud-finder married to a precision nail gun.” says Matt Johnson, a analysis workforce member from the laboratory’s Human Well being and Efficiency Techniques Group.

AI-GUIDE is a platform system manufactured from custom-built algorithms and built-in robotics that might pair with most business moveable ultrasound units. To function AI-GUIDE, a person first locations it on the affected person’s physique, close to the place the thigh meets the stomach. A easy focusing on show guides the person to the proper location after which instructs them to tug a set off, which exactly inserts the needle into the vessel. The system verifies that the needle has penetrated the blood vessel, after which prompts the person to advance an built-in guidewire, a skinny wire inserted into the physique to information a bigger instrument, equivalent to a catheter, right into a vessel. The person then manually advances a catheter. As soon as the catheter is securely within the blood vessel, the system withdraws the needle and the person can take away the system.

With the catheter safely contained in the vessel, responders can then ship fluid, drugs, or different interventions.

AI-GUIDE automates almost each step of the method to find and insert a needle, guidewire, and catheter right into a blood vessel to facilitate lifesaving remedy. The model of the system proven right here is optimized to find the femoral blood vessels, that are within the higher thigh. Picture courtesy of the researchers.

As straightforward as urgent a button

The Lincoln Laboratory workforce developed the AI within the system by leveraging expertise used for real-time object detection in photos.

“Utilizing switch studying, we skilled the algorithms on a big dataset of ultrasound scans acquired by our scientific collaborators at MGH,” says Lars Gjesteby, a member of the laboratory’s analysis workforce. “The pictures include key landmarks of the vascular anatomy, together with the widespread femoral artery and vein.”

These algorithms interpret the visible information coming in from the ultrasound that’s paired with AI-GUIDE after which point out the proper blood vessel location to the person on the show.

“The great thing about the on-device show is that the person by no means must interpret, and even see, the ultrasound imagery,” says Mohit Joshi, the workforce member who designed the show. “They’re merely directed to maneuver the system till a rectangle, representing the goal vessel, is within the middle of the display.”

For the person, the system could seem as straightforward to make use of as urgent a button to advance a needle, however to make sure speedy and dependable success, quite a bit is going on behind the scenes. For instance, when a affected person has misplaced a big quantity of blood and turns into hypotensive, veins that might usually be spherical and filled with blood grow to be flat. When the needle tip reaches the middle of the vein, the wall of the vein is more likely to “tent” inward, moderately than being punctured by the needle. Consequently, although the needle was injected to the correct location, it fails to enter the vessel.

To make sure that the needle reliably punctures the vessel, the workforce engineered the system to have the ability to examine its personal work.

“When AI-GUIDE injects the needle towards the middle of the vessel, it searches for the presence of blood by creating suction,” says Josh Werblin, this system’s mechanical engineer. “Optics within the system’s deal with set off when blood is current, indicating that the insertion was profitable.” This method is a part of why AI-GUIDE has proven very excessive injection success charges, even in hypotensive eventualities the place veins are more likely to tent.

Lincoln Laboratory researchers and physicians from the Massachusetts Common Hospital Middle for Ultrasound Analysis and Translation collaborated to construct the AI-GUIDE system. Picture courtesy of Massachusetts Common Hospital.

Just lately, the workforce printed a paper within the journal Biosensors that reviews on AI-GUIDE’s needle insertion success charges. Customers with medical expertise starting from zero to larger than 15 years examined AI-GUIDE on a synthetic mannequin of human tissue and blood vessels and one knowledgeable person examined it on a collection of stay, sedated pigs. The workforce reported that after solely two minutes of verbal coaching, all customers of the system on the unreal human tissue had been profitable in inserting a needle, with all however one finishing the duty in lower than one minute. The knowledgeable person was additionally profitable in rapidly inserting each the needle and the built-in guidewire and catheter in a few minute. The needle insertion velocity and accuracy had been corresponding to that of skilled clinicians working in hospital environments on human sufferers. 

Theodore Pierce, a radiologist and collaborator from MGH, says AI-GUIDE’s design, which makes it secure and straightforward to make use of, instantly interprets to low coaching necessities and efficient efficiency. “AI-GUIDE has the potential to be sooner, extra exact, safer, and require much less coaching than present guide image-guided needle placement procedures,” he says. “The modular design additionally permits straightforward adaptation to quite a lot of scientific eventualities past vascular entry, together with minimally invasive surgical procedure, image-guided biopsy, and imaging-directed most cancers remedy.”

In 2021, the workforce obtained an R&D 100 Award for AI-GUIDE, recognizing it among the many yr’s most modern new applied sciences obtainable for license or available on the market. 

What’s subsequent?

Proper now, the workforce is constant to check the system and work on absolutely automating each step of its operation. Particularly, they need to automate the guidewire and catheter insertion steps to additional cut back threat of person error or potential for an infection.

“Retraction of the needle after catheter placement reduces the prospect of an inadvertent needle harm, a critical complication in observe which may end up in the transmission of illnesses equivalent to HIV and hepatitis,” says Pierce. “We hope {that a} discount in guide manipulation of procedural elements, ensuing from full needle, guidewire, and catheter integration, will cut back the chance of central line an infection.”

AI-GUIDE was constructed and examined inside Lincoln Laboratory’s new Digital Integration Expertise Lab (VITL). VITL was constructed with a purpose to deliver a medical system prototyping functionality to the laboratory.

“Our imaginative and prescient is to quickly prototype clever medical units that combine AI, sensing — significantly moveable ultrasound — and miniature robotics to handle essential unmet wants for each navy and civilian care,” says Laura Brattain, who’s the AI-GUIDE mission co-lead and likewise holds a visiting scientist place at MGH. “In working intently with our scientific collaborators, we goal to develop capabilities that may be rapidly translated to the scientific setting. We count on that VITL’s position will proceed to develop.”

AutonomUS, a startup firm based by AI-GUIDE’s MGH co-inventors, not too long ago secured an choice for the mental property rights for the system. AutonomUS is actively searching for buyers and strategic companions.

“We see the AI-GUIDE platform expertise turning into ubiquitous all through the health-care system,” says Johnson, “enabling sooner and extra correct remedy by customers with a broad vary of experience, for each pre-hospital emergency interventions and routine image-guided procedures.”

This work was supported by the U.S. Military Fight Casualty Care Analysis Program and Joint Program Committee – 6. Nancy DeLosa, Forrest Kuhlmann, Jay Gupta, Brian Telfer, David Maurer, Wes Hill, Andres Chamorro, and Allison Cheng offered technical contributions, and Arinc Ozturk, Xiaohong Wang, and Qian Li offered steerage on scientific use.


MIT Information



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