MRI-guided robot-assisted lumpectomy for surgical management of early breast cancer: Preliminary investigation and use case analysis

Dynamic contrast enhanced magnetic resonance imaging (DCE MRI) in combination with ultrasound and/or X-ray imaging offers an excellent roadmap for intraoperative surgical guidance for complete excision of the true extent of disease in early stage breast cancer. However, incorporation of image-guidance in the operating room is challenging due to patient positioning, precise targeting under tissue deformation, instrument incompatibility and limited maneuverability, and complex human-technology interface. In this paper, we outline a novel strategy and preliminary simulation data on a proposed robot-assisted lumpectomy technique in the prone position using DCE MRI for real-time guidance. Extension to CT guidance for X-ray enhancing lesions would require minimal additional specifications. For ultrasound enhancing lesions, a method to ensure co-registration of the target with MRI is presented.