Project Summary Vertebral compression fractures (VCFs) are effectively treated with vertebral augmentation (VA), which rapidly reduces pain and restores function. The most significant opportunities to advance VA as an efficacious treatment option for (cancer) patients in acute pain are to 1) considerably reduce radiation dose to patient and staff; 2) improve the safety of VA; and 3) increase its efficacy by establishing superior but more complex techniques using curved instruments. Introducing robotic systems for VA will address these three significant challenges. However, existing robotic solutions are bulky, expensive to acquire and maintain, and disrupt workflows. These drawbacks make current systems inadequate for VA, a quick procedure that is often performed in outpatient settings. To capitalize on the benefits of robotics for VA – reduced radiation dose and complication rates, and increased efficacy – novel, alternative robotic platforms and corresponding algorithms are needed that seamlessly integrate with the VA workflow, enable robot planning from interventional X-ray images, and are more affordable. Our long-term goal is to advance surgical robotics technology for X-ray-guided VA by developing 1) a novel class of tool-mounted robots, 2) a suite of powerful image-based algorithms for automated intra-operative surgical planning, verification, and closed loop control, and 3) mixed reality interfaces for remote actuation and assurance. Because our robotic solution augments the conventional VA workflow and its tools, and is of considerably lower cost than existing robotic solutions, our developments will contribute to unlocking the known benefits of surgical robotics for the surgical treatment of the tens of thousands of VAs that are performed across a wide variety of providers every year in the US. Our specific aims are: 1) Develop and test a cannula- mounted piezo robot for image-guided VA: We will create a cannula-mounted piezo robot, supported by a passive positioning arm, that meets the clinical requirements of VA. The robot will combine high accuracy and force with a low-profile design to not interfere with X-ray image-guidance. 2) Develop imaging and planning algorithms, and user feedback to guide delivery: We will develop algorithms for a camera-augmented C-arm X-ray system to acquire and interpret X-ray and RGB-D images to achieve automated planning and guidance. Via mixed reality, they will guide providers through the semi-automated workflow to ensure safe and accurate execution. 3) Demonstrate integrated system performance ex vivo: We will confirm the functional performance, reliability, and overall system accuracy of our robotic approach through a series of cadaver studies. Our multi-disciplinary team will be the first to investigate tool-mounted robots for hard-tissue surgery, paving the way for a new family of robots that are compact and exert sufficient force for bone surgery. Combin- ing innovative robotic actuators with powerful algorithms for automated planning and remote-actuation will provide alternative robotic solutions that will contribute to a more widespread adoption of robotic surgery.

Project Narrative Vertebral compression fractures, the most common fragility fractures secondary to osteoporosis, are effectively treated with vertebral augmentation, which rapidly reduces pain and restores function. The goal of this project is to advance surgical robotics technology for vertebral augmentation to reduce radiation dose, increase safety, and improve efficacy. This will be accomplished by developing a novel class of tool-mounted robots and a suite of powerful image-based algorithms for automated intra-operative planning, verification, and control, integrated in mixed reality for remote actuation and assurance.