PROJECT SUMMARY Abdominal cancers are a devastating cause of morbidity and mortality worldwide. For example, hepatocellular carcinoma (HCC) has a grim five-year survival rate of less than 20% and is the fastest rising cause of cancer- related deaths in the U.S. Early and accurate diagnosis is crucial, as curative treatment is feasible by surgical resection and/or focal ablation. Compared to surgery, focal ablation reduces hospital stay, increases preservation of surrounding normal tissues, and decreases treatment-related morbidities. However, focal ablation still faces critical limitations in applicability and effectiveness due to inadequate image guidance and procedural accuracy provided by current approaches. Consequently, there is a pressing need to establish new minimally invasive interventions to improve the diagnosis and treatment of abdominal cancers. Conventional abdominal interventions rely on image guidance by ultrasound and/or computed tomography (CT), which can fail to provide sufficient visualization of the cancerous lesions. In addition, CT utilizes ionizing radiation and cannot be used for real-time imaging throughout an intervention. Magnetic resonance imaging (MRI) has crucial advantages that make it ideal for real-time guidance of abdominal interventions: it is the best and/or only way to visualize HCC and several types of abdominal cancers, has no ionizing radiation, and has the potential for real- time imaging of abdominal organs that are constantly in motion. However, current real-time MRI suffers from compromises in image quality, time latency, and difficulties in tracking the devices and tissue targets during motion. Furthermore, the narrow physical space of MRI scanners severely impedes the physician’s access to the patient inside the scanner during imaging. As a result, current MRI-guided interventions require cumbersome workflows that hamper the accuracy and efficiency. The objective of this proposal is to overcome these challenges and enable real-time MRI-guided abdominal interventions. The interdisciplinary research team will leverage synergistic innovations in (1) real-time MRI and computer-aided guidance methods, (2) MRI-compatible robotics, and (3) computer-aided feedback control methods and interactive user interfaces to create a new real-time MRI-guided robotic system. The system will be evaluated in programmable dynamic tissue phantoms and in vivo pig liver models to achieve safe, accurate, and efficient needle placement in moving targets – the foundation for all abdominal interventions. This new robotic system will enable next-generation real-time MRI-guided interventions that can positively impact the diagnosis and treatment of patients with liver tumors and abdominal cancers.

PROJECT NARRATIVE Image-guided minimally invasive interventions, including targeted biopsy and focal ablation, promise to be safe and effective strategies for the diagnosis and treatment of abdominal cancers, but currently face critical limitations due to inadequate image guidance and procedural accuracy provided by existing technologies. This work will overcome these challenges by creating a new real-time magnetic resonance imaging (MRI) guided robotic system based on synergistic innovations in real-time MRI and computer-aided guidance methods, MRI-compatible robotics, feedback control methods, and interactive user interfaces. The new system will be evaluated in programmable dynamic tissue phantoms and in vivo pig liver models to demonstrate its safety, accuracy, and efficiency for needle placement in moving targets, which will establish the foundation for a new generation of minimally invasive interventions to improve the management of abdominal cancers.