title: Precision grid and hand motion for accurate needle insertion in brachytherapy.
abstract: OBJECTIVE
  In prostate brachytherapy, a grid is used to guide a needle tip toward a preplanned location within the tissue. During insertion, the needle deflects en route resulting in target misplacement. In this paper, 18-gauge needle insertion experiments into phantom were performed to test effects of three parameters, which include the clearance between the grid hole and needle, the thickness of the grid, and the needle insertion speed. Measurement apparatus that consisted of two datum surfaces and digital depth gauge was developed to quantify needle deflections.
  
  
  METHODS
  The gauge repeatability and reproducibility (GR&R) test was performed on the measurement apparatus, and it proved to be capable of measuring a 2 mm tolerance from the target. Replicated experiments were performed on a 2(3) factorial design (three parameters at two levels) and analysis included averages and standard deviation along with an analysis of variance (ANOVA) to find significant single and two-way interaction factors.
  
  
  RESULTS
  Results showed that grid with tight clearance hole and slow needle speed increased precision and accuracy of needle insertion. The tight grid was vital to enhance precision and accuracy of needle insertion for both slow and fast insertion speed; additionally, at slow speed the tight, thick grid improved needle precision and accuracy.
  
  
  CONCLUSIONS
  In summary, the tight grid is important, regardless of speed. The grid design, which shows the capability to reduce the needle deflection in brachytherapy procedures, can potentially be implemented in the brachytherapy procedure.
authors.affiliation: Biomedical Engineering Department, University of Michigan, Ann Arbor, Michigan 48109, USA. cmcgillz@umich.edu
authors.forename: Carl S
authors.initials: CS
authors.lastname: McGill
authors.forename: Jonathon A
authors.initials: JA
authors.lastname: Schwartz
authors.forename: Jason Z
authors.initials: JZ
authors.lastname: Moore
authors.forename: Patrick W
authors.initials: PW
authors.lastname: McLaughlin
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Shih
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D004867:Equipment Design; D006225:Hand; D006801:Humans; D008297:Male; D009068:Movement; D009339:Needles; D019047:Phantoms, Imaging; D010865:Pilot Projects; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011897:Random Allocation; D015203:Reproducibility of Results