1. Field of the Disclosure
The disclosure relates generally to biopsy needles and, more particularly, to biopsy needles capable of cauterizing the needle tract.
2. Brief Description of Related Technology
Needle aspiration biopsy is a diagnostic procedure used to investigate thyroid, breast, liver and lung cancers. Even though percutaneous biopsies are generally safe, there have been reports of potential risks such as deposition of viable tumor cells or “seeding” along the needle tract. The rate of seeding can vary from 5.1%-12.5%. Studies also suggest that post biopsy hemorrhage (bleeding) can be as high as 18.3%-23%. Further, this percentage can be higher for patients with cirrhosis and uncorrected coagulopathy. Infection is also a potential risk.
Past work had been limited to using radio frequency (RF) ablation of needle tracts. For instance, in one method, the outside of a biopsy needle, except for the last two centimeters, was coated with a thin layer of electrical insulation. A source of RF electrical power was then connected to the biopsy needle as it was withdrawn from the body, to provide electro-cauterization of the needle tract. Comparison of hemorrhage after liver and kidney biopsy, with and without ablation of the needle tract, was reported in W. F. Pritchard et al., “Radiofrequency cauterization with biopsy introducer needle,” J Vasc Intery Radiol, 15, pp. 183-187, 2004. Here, RF ablation by an introducer needle was employed as the ablation procedure. This study suggested that RF ablation reduces bleeding as compared to absence of RF ablation, in liver and kidney procedures, with mean blood loss reduced by 63% and 97%, respectively.
In an embodiment, a medical device such as a biopsy needle or probe has an integrated piezoelectric transducer. A power source is electrically coupled to the piezoelectric transducer. The power source is configured to generate a signal that causes the piezoelectric transducer to generate heat for cauterizing tissue.
In another embodiment, a medical procedure comprises inserting a medical device, such as a biopsy needle or a probe, into tissue of a patient. A piezoelectric transducer is integrated with the medical device. A power source electrically coupled to the piezoelectric transducer is used to cause the piezoelectric transducer to generate heat to cauterize tissue. Then, the medical probe is extracted.
In still another embodiment, a medical device such as a biopsy needle or probe has an integrated piezoelectric transducer. The piezoelectric transducer is connected to a power source that causes the piezoelectric transducer to generate heat to cauterize tissue. A control unit coupled to the power source monitors a signal from the medical device and controls the power source accordingly.
In another embodiment, a medical device such as a biopsy needle or probe has an integrated piezoelectric transducer. The piezoelectric transducer is electrically coupled to a power source and a servo. The servo is mechanically coupled to the medical device. A control unit, electrically coupled to both the servo and the power source, operates to control one or both of the servo and the power source according to a signal received from the piezoelectric transducer and/or the sensor.
Ultrasonic heating using piezoceramics holds significant promise as a tool for tissue cauterization. In some embodiments, ultrasonic heating using piezoceramics can be combined with ultrasonic tissue density measurements for determining completion of tissue cauterization. In an embodiment, heat generation in 3.2 mm diameter lead zirconate titanate (PZT) discs is used for biological tissue cauterization. In an embodiment, an array of 200 μm diameter bulk micromachined PZT transducers integrated with a 20-gauge biopsy needle provides for cauterization of the needle tract. In another embodiment, a single PZT transducer is utilized. In other embodiments, a single PZT transducer or an array of PZT transducers are mounted to a medical instrument other than a biopsy needle (such as a probe), or to a needle other than a 20-gauge biopsy needle, to provide for fine tissue cauterization.
In an embodiment, the biopsy needle assembly 101 and, in particular, the biopsy needle 102 may include one or more sensors 118 integrated with the biopsy needle 102 and proximate to the tip 110. The one or more sensors 118 may be utilized to determine the extent of cauterization. For example, the one or more sensors 118 may comprise one or piezoelectric sensors. In this embodiment, the system 100 may include a signal analyzer 108, for example, an impedance analyzer, electrically coupled to the one or more sensors 118. The signal analyzer 108 may determine one or more resonance frequencies of the one or more piezoelectric sensors 118. As described in U.S. patent application Ser. No. 11/625,801, entitled “In-situ Tissue Analysis Device and Method,” filed on Jan. 22, 2007, which is hereby incorporated by reference herein, the resonance frequency of a piezoelectric sensor changes depending on the density of the tissue proximate to the piezoelectric sensor. Additionally, cauterized tissue has a different storage modulus than uncauterized tissue. Thus, the one or more piezoelectric sensors 118 can be utilized to determine the extent of cauterization (e.g., the depth and/or degree of cauterization of tissue in contact with the sensor/needle surface). In particular, the signal analyzer 108 may be utilized to monitor the resonance frequency of a piezoelectric sensor 118 to determine the extent of cauterization.
In another embodiment, the one or more piezoelectric transducers 106 used for cauterization are also configured for use as a sensor 118 to sense the degree of cauterization. For example, the piezoelectric transducers 106 can be utilized as sensors as described in U.S. patent application Ser. No. 11/625,801. As also described in U.S. patent application Ser. No. 11/625,801, in an embodiment, the piezoelectric transducers 106 and/or the sensors 118 aid in guiding the needle tip 110 to a target tissue (e.g., a tumor) by, for example, sensing changes in a property of a tissue which changes indicate a tissue boundary (e.g., the boundary between a tumor and the tissue in which the tumor is located).
In an embodiment, the biopsy needle 102 is a fine needle aspiration biopsy needle. For example, the needle 102 may be a 20-gauge needle, a 22-gauge needle, or a 25-gauge needle. In another embodiment, the needle is a non-needle probe. The non-needle probe may be used, for example, to cauterize or ablate target tissue (e.g., a tumor), which may be detected by the sensor 118. In still another embodiment, the needle is not a biopsy needle, but could be, for example, an injection needle. In the latter case, the injection needle may be used to deliver an injected substance to the target tissue, which may be detected using the sensors 118.
Temperature Profile Model
An example 3D finite element model was developed to estimate the temperature profile in the tissues. Pennes' bioheat transfer model was used to model heat transfer in tissues. This model takes into account the cooling due to blood flow in tissues. The model is given by:
where ρt is the density of the medium, ct is the specific heat capacity, k is the thermal conductivity, T is the temperature, ρb is the density of blood, cb is the specific heat capacity of blood, ωb is the perfusion rate of the blood, Tb is the arterial blood temperature and q is the heat generation rate per unit volume due to ultrasound applicator.
In a biopsy needle embodiment, PZT heaters are significantly smaller than the size of the needle. Hence, in a biopsy needle embodiment, the heaters can be modeled as small spherical sources. The heat generation rate from the PZT heater is given by:
where α is the ultrasound absorption coefficient (Np·m−1), IS is the ultrasound intensity along the surface of the transducer (Wm−2), r is the radial distance from the center of the transducer and r0 is the radius of the transducer. The term μ is the ultrasound attenuation and is taken equal to a under the assumption that all the attenuated acoustic energy is absorbed by the local medium. However, due to inefficiencies in the transducer, not all the electrical energy applied to it gets converted into acoustic energy. This unconverted energy is dissipated as heat within the transducer. For a given transducer efficiency, ν, the heat generation rate per unit volume within the transducer is given by:
The cooling due to blood flow was considered only in the biological tissue region. The heat generation rate given in equation 2 was used in epoxy, needle and tissue regions. The heat generation rate given by equation 3 was used in the PZT region. The outer surface of the tissue and the far end tip of the needle (outside the tissue region) were maintained at 310 K and 300 K, respectively. In the simulations, transducer efficiency was assumed to be 0.52.
Electrical Impedance Model
In a needle 102 having one or more piezoelectric transducers 106 for cauterizing and/or ablating tissue, one or more sensors 118 in the needle 102 may detect changes in the impedance characteristics of the sensor 106 (e.g., one or more PZT discs 120) due to the cauterization.
The resonance frequency and magnitude of the electromechanical impedance of a PZT-embedded structure depend on the density, elastic modulus and loss factor of the surrounding medium. The elastic modulus and loss factor in the tissue increases after ablation, thereby providing a method for monitoring tissue cauterization. A modified Butterworth-Van-Dyke (BVD) circuit model (see
where kt is the electro-mechanical coupling constant, η0 is the viscosity of PZT layer, ρ0 is the density of PZT, A is the area of PZT, v0 is the acoustic velocity in PZT, t0 is the PZT thickness and ∈ is the dielectric permittivity in PZT. The resonance frequency, fm (at minimum impedance), and the anti-resonance frequency, fan (at maximum impedance), are given by:
The effect of tissue loading is modeled by adding the resistor Rtn and inductor Ltn to the motional branches of the circuit. For a semi-infinite viscoelastic medium Rtn and Ltn are given by:
where G=G′+iηω, Zq=√{square root over (E0ρ0)}, E0 is the Young's modulus of PZT, ρt is the tissue density, ω is the operation frequency, G′ is the tissue storage modulus, η is the loss factor in tissue, and Zq is the PZT acoustic impedance. Table 2 lists the material properties used in the model. The fundamental anti-resonance frequency, which is the mode to be used for experiments, when the biopsy needle tip is in air, and in tissue before cauterization and after cauterization, is shown in
Experimental Device Design and Fabrication
In an experimental device, PZT discs were fabricated from PZT-5A material. This material has a Curie temperature of 350° C., which is greater than the target temperature of 70-100° C. (ΔT=33−63° C.). Circular shaped PZT devices were used because for a given volume device, these generate higher temperature rise per unit voltage as compared to square and rectangular devices.
Operating Frequency
PZT discs may be characterized to determine the operating frequency that provides maximum thermal efficiency.
(12)
where far is the anti-resonance frequency and fr is the resonance frequency. For the case in which a PZT disc 120 is bonded to a brass substrate, mode 2 was observed to be suitable.
Experimental Results—Temperature Profile
The temperature profile generated by a first experimental biopsy tool was measured at two resonance modes: the radial mode (10.3 MHz) and the thickness mode (22.3 MHz). PZT discs 120 were actuated using a sinusoidal wave at the respective resonance frequencies using the signal generator 112 amplified using the power amplifier 114. The temperature was measured using a K-type thermocouple (not shown) read using a digital thermometer. The experiments were performed by inserting the needle 102 of the needle assembly 101 into porcine tissue samples.
Experimental Results—Electrical Impedance
Additional experiments were conducted by inserting a second experimental biopsy tool into a porcine tissue sample. The porcine tissue sample was cauterized by actuating the PZT discs 120 with an RMS voltage of 14 V as their fundamental anti-resonance frequency of 9.6 MHz. The impedance characteristics of the PZT discs 120 were measured using an Agilent 4395A impedance analyzer. All impedance measurements were conducted at room temperature, unless otherwise stated.
The variation in fa1 was also measured with temperature varied in the range for cauterization while the needle tip stayed in air. Even though fa1 decreased (from 11.92 MHz to 11.38 MHz) with increasing temperature (from 22° C. to 78° C.), it was observed that fa1 returned to its initial value when the needle 102 was cooled down to room temperature (
Cauterizing Tissue
At block 212, tissue is cauterized using the one or more piezoelectric transducers 106. In an embodiment, block 212 may comprise providing signals to the one or more piezoelectric transducers 106 having signal components corresponding to resonant frequencies of the one or more piezoelectric transducers 106. Block 212 may be performed while the needle 102 is stationary and/or while the needle 102 is slowly being withdrawn so that the needle tract is cauterized along the length of the tract.
If the system includes a sensor 118, at block 216, the sensor 118 is utilized to determine an extent of cauterization. In an embodiment, a piezoelectric sensor 118 is utilized to sense differences in the density of tissue proximate to the sensor, which differences indicating a degree of cauterization. At block 220, cauterization is stopped when a desired degree of cauterization is achieved. In an embodiment, the piezoelectric transducer or transducers 106 receiving the signals and cauterizing the tissues may be utilized to determine an extent of cauterization. The transducers 106 and/or the sensors 118 may be used to determine an extent of cauterization by analyzing, for example with an impedance analyzer, the anti-resonance frequency and/or impedance magnitude of the transducers 106 and/or the sensors 118.
The blocks 212 and 216 may be performed alternately. For example, a time duration of cauterization may occur followed by a time duration of sensing, and the alternation repeating until the desired degree of cauterization is achieved. The blocks 212 and 216 may be performed while the needle is stationary and/or while the needle is slowly being withdrawn.
Automation
In some embodiments, the system 100 described above may be integrated into an automated system for performing a biopsy and/or for performing a cauterization process.
The servos 232 are mechanically coupled to the needle assembly 101 to manipulate the needle assembly 101. In some embodiments, the system 230 includes five servos 232 that allow the system 230 to manipulate the needle 102 with five degrees of freedom. For example, such a system 230 may move the needle along x- and y-axes orthogonal to the length of the needle 102 and to each other, along a z-axis aligned with the length of the needle 102 and orthogonal with each of the x- and y-axes (e.g., into and out of the patient), and may pivot the needle 102 about the x- and y-axes. Of course, in other embodiments, this degree of flexibility may be unnecessary and fewer servos 232 may be used. Minimally, a single servo 232 may be employed to move the needle 102 in a direction aligned with the length of the needle 102.
The system 230 may employ a control unit 234 to provide control signals to the servos 232. The control unit 234 includes a processor 236, a memory device 238, an input/output (I/O) interface 240, and a user interface 242. The control unit 234 may be electrically coupled to one or both of the signal analyzer 108 and the power source 104 via the I/O interface 240. The control unit 234 may also be electrically coupled to the servos 232 via the I/O interface 240. The processor 236 may execute one or more sets of instructions (e.g., programs, algorithms, etc.) stored in the memory device 238. The sets of instructions, or routines, stored in the memory device 238 may include a routine for allowing a user (e.g., a doctor, technician, etc.) to adjust a position of the needle 102 (e.g., by causing movement of the servos 232) through the user interface 242 prior to executing an automated procedure. One routine may allow the user to set parameters for the automated procedure. A routine may also operate to cause the control unit 234 to transmit a signal to the power source 104. The transmitted signal may perform a control action on the signal generator 112 or the power amplifier 114. For example, the transmitted signal may configure either or both of the signal generator 112 and the power amplifier 114 according to parameters entered through the user interface 242 by the user. Parameters may include the waveform parameters (e.g., voltage, waveform shape, frequency, etc.) and amplification factors for the signal transmitted to the transducer 106. Further, in some embodiments, a routine may cause the control unit 234 to send and/or receive one or more signals from the signal analyzer 108. The routine may cause the control unit 234 to configure the signal analyzer 108 to receive a signal from the sensor 118 or the transducer 106 and to determine whether the tissue in contact with the needle 102 has been adequately cauterized. At the same time, a routine may cause the control unit 234 to operate the servos 232 and/or adjust (e.g., reconfigure) one or more parameters of the power source 104 according to the determination of the signal analyzer 108. In one embodiment, a routine causes the control unit 234 to configure the signal analyzer 108 to receive and analyze a signal from a sensor 118 to determine when the tip 110 of the needle 102 has crossed a tissue boundary, for example, to prevent cauterization of certain tissue, or to guide the needle 102 to a target tissue. Of course, functionality of the one or more of the routines described above may be combined into fewer routines and/or separated into more routines.
While the control unit 234 is depicted in
Although devices and techniques described above were in the context of biopsies, one of ordinary skill in the art will recognize that these cauterization devices and techniques can be utilized in other contexts as well. For example, a probe device could be used to cauterize a tumor or growth, or to stop source of bleeding. Similarly, one or more transducers, and optionally one or more sensors, could be mounted proximate to some other surgical tool to permit cauterization and optionally measuring the degree of cauterization using the surgical tool.
Properties or changes in properties sensed by the sensor(s) could be indicated to a physician, technician, etc., in a variety of ways. For example, properties or changes in properties could be indicated visually, audibly, with force feedback, etc. A computing device could be communicatively coupled to the sensors and/or to an interface device or devices (which is in turn communicatively coupled to the sensor(s)). The communication device could generate indications based on the properties or changes in properties sensed by the sensor(s).
While the present invention has been described with reference to specific examples, which are intended to be illustrative only and not to be limiting of the invention, it will be apparent to those of ordinary skill in the art that changes, additions and/or deletions may be made to the disclosed embodiments without departing from the spirit and scope of the invention.
The foregoing description is given for clearness of understanding only, and no unnecessary limitations should be understood therefrom, as modifications within the scope of the invention may be apparent to those having ordinary skill in the art.
The present application claims the benefit of U.S. Provisional Application No. 61/297,547, entitled “CAUTERIZATION DEVICE AND METHOD OF CAUTERIZING,” filed on Jan. 22, 2010, which is hereby incorporated by reference herein in its entirety.
This invention was made with government support under N66001-07-1-2006 awarded by Navy/SPAWAR, and under EECS 0734962 awarded by the National Science Foundation. The government has certain rights in the invention.
Number | Date | Country | |
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61297547 | Jan 2010 | US |