Computed tomography (CT)-guided needle biopsies are critical for diagnosing a range of conditions, including lung cancer, but present challenges such as limited in-bore space, prolonged procedure times, and radiation exposure. Robotic assistance offers a promising solution by improving needle trajectory accuracy, reducing radiation exposure, and enabling real-time adjustments. In our previous work, we introduced a redundant robotic platform designed for dexterous needle insertion within the confined CT bore. However, its limited base mobility restricts flexible deployment in clinical settings. In this study, we present an improved 11-degree-of-freedom (DOF) robotic system that integrates a 6-DOF robotic base with a 5-DOF cable-driven end-effector, significantly enhancing workspace flexibility and precision. With the hyper-redundant degrees of freedom, we introduce a weighted inverse kinematics controller with a two-stage priority scheme for large-scale movement and fine in-bore adjustments, along with a null-space control strategy to optimize dexterity. We validate our system through both simulation and real-world experiments, demonstrating superior tracking accuracy and enhanced manipulability in CT-guided procedures. The study provides a strong case for hyper-redundancy and null-space control formulations for robot-assisted needle biopsy scenarios.

The role of artificial intelligence (AI) in pathology has evolved from aiding diagnostics to uncovering predictive morphological patterns in whole slide images (WSIs). Recently, foundation models (FMs) leveraging self-supervised pre-training have been widely advocated as a universal solution for diverse downstream tasks. However, open questions remain about their clinical applicability and generalization advantages over end-to-end learning using task-specific (TS) models. Here, we focused on AI with clinical-grade performance for prostate cancer diagnosis and Gleason grading. We present the largest validation of AI for this task, using over 100,000 core needle biopsies from 7,342 patients across 15 sites in 11 countries. We compared two FMs with a fully end-to-end TS model in a multiple instance learning framework. Our findings challenge assumptions that FMs universally outperform TS models. While FMs demonstrated utility in data-scarce scenarios, their performance converged with - and was in some cases surpassed by - TS models when sufficient labeled training data were available. Notably, extensive task-specific training markedly reduced clinically significant misgrading, misdiagnosis of challenging morphologies, and variability across different WSI scanners. Additionally, FMs used up to 35 times more energy than the TS model, raising concerns about their sustainability. Our results underscore that while FMs offer clear advantages for rapid prototyping and research, their role as a universal solution for clinically applicable medical AI remains uncertain. For high-stakes clinical applications, rigorous validation and consideration of task-specific training remain critically important. We advocate for integrating the strengths of FMs and end-to-end learning to achieve robust and resource-efficient AI pathology solutions fit for clinical use.

Purpose: We present a virtual model to optimize point of entry (POE) in lung biopsy planning systems. Our model allows to compute the quality of a biopsy sample taken from potential POE, taking into account the margin of error that arises from discrepancies between the orientation in the planning simulation and the actual orientation during the operation. Additionally, the study examines the impact of the characteristics of the lesion. Methods: The quality of the biopsy is given by a heatmap projected onto the skeleton of a patient-specific model of airways. The skeleton provides a 3D representation of airways structure, while the heatmap intensity represents the potential amount of tissue that it could be extracted from each POE. This amount of tissue is determined by the intersection of the lesion with a cone that represents the uncertainty area in the introduction of biopsy instruments. The cone, lesion, and skeleton are modelled as graphical objects that define a 3D scene of the intervention. Results: We have simulated different settings of the intervention scene from a single anatomy extracted from a CT scan and two lesions with regular and irregular shapes. The different scenarios are simulated by systematic rotation of each lesion placed at different distances from airways. Analysis of the heatmaps for the different settings show a strong impact of lesion orientation for irregular shape and the distance for both shapes. Conclusion: The proposed heatmaps help to visually assess the optimal POE and identify whether multiple optimal POEs exist in different zones of the bronchi. They also allow us to model the maximum allowable error in navigation systems and study which variables have the greatest influence on the success of the operation. Additionally, they help determine at what point this influence could potentially jeopardize the operation.

As global life expectancy increases, so does the burden of chronic diseases, yet individuals exhibit considerable variability in the rate at which they age. Identifying biomarkers that distinguish fast from slow ageing is crucial for understanding the biology of ageing, enabling early disease detection, and improving prevention strategies. Using contrastive deep learning, we show that skin biopsy images alone are sufficient to determine an individual's age. We then use visual features in histopathology slides of the skin biopsies to construct a novel biomarker of ageing. By linking with comprehensive health registers in Denmark, we demonstrate that visual features in histopathology slides of skin biopsies predict mortality and the prevalence of chronic age-related diseases. Our work highlights how routinely collected health data can provide additional value when used together with deep learning, by creating a new biomarker for ageing which can be actively used to determine mortality over time.

Since the needle will be discretized into discrete elements, the Percutaneous needle interventions capture a broad class of complete state of the needle, and the simulation environment minimally invasive diagnosis and treatment procedures, such in general, could involve hundreds of variables, and planning as biopsy [1]-[3], brachytherapy [4], [5], and spinal injection for a minimally invasive insertion and closed-loop control of [6]-[8]. Depending on the clinical procedure, a range the flexible needle becomes a challenging problem. of needles with different gauges, stiffness levels, and tip geometries is available. These inherent needle characteristics Previous works in this domain focus primarily on resolvedrate play a crucial role in determining how the needle moves control, which relies on inverting a numerical inputoutput through soft biological tissues; additionally, surgeons also Jacobian matrix obtained either via Broyden's update employ various techniques, such as rotating or bending the law or simulating small input disturbances [10], [13], [15]- needle, to adjust the position of the needle tip in situ during [18]. Yet obtaining such invertible mapping can be challenging, insertion.

MRI-targeted biopsy has shown significant advantages over conventional random sextant biopsy, detecting more clinically significant cancers and improving risk stratification. However, needle targeting accuracy, especially in transperineal MRI-guided biopsies, presents a challenge due to needle deflection. This can negatively impact patient outcomes, leading to repeated sampling and inaccurate diagnoses if cancerous tissue isn't properly collected. To address this, we developed a novel differential drive prototype designed to improve needle control and targeting precision. This system, featuring a 2-degree-of-freedom (2-DOF) MRI-compatible cooperative needle driver, distances the robot from the MRI imaging area, minimizing image artifacts and distortions. By using two motors for simultaneous needle insertion and rotation without relative movement, the design reduces MRI interference. In this work, we introduced two mechanical differential drive designs: the ball screw/spline and lead screw/bushing types, and explored both hollow-type and side-pulley differentials. Validation through low-resolution rapid-prototyping demonstrated the feasibility of differential drives in prostate biopsies, with the custom hollow-type hybrid ultrasonic motor (USM) achieving a rotary speed of 75 rpm. The side-pulley differential further increased the speed to 168 rpm, ideal for needle rotation applications. Accuracy assessments showed minimal errors in both insertion and rotation motions, indicating that this proof-of-concept design holds great promise for further development. Ultimately, the differential drive offers a promising solution to the critical issue of needle targeting accuracy in MRI-guided prostate biopsies.

Microscopic interpretation of histopathology images underlies many important diagnostic and treatment decisions. While advances in vision-language modeling raise new opportunities for analysis of such images, the gigapixel-scale size of whole slide images (WSIs) introduces unique challenges. Additionally, pathology reports simultaneously highlight key findings from small regions while also aggregating interpretation across multiple slides, often making it difficult to create robust image-text pairs. As such, pathology reports remain a largely untapped source of supervision in computational pathology, with most efforts relying on region-of-interest annotations or self-supervision at the patch-level. In this work, we develop a vision-language model based on the BLIP-2 framework using WSIs paired with curated text from pathology reports. This enables applications utilizing a shared image-text embedding space, such as text or image retrieval for finding cases of interest, as well as integration of the WSI encoder with a frozen large language model (LLM) for WSI-based generative text capabilities such as report generation or AI-in-the-loop interactions. We utilize a de-identified dataset of over 350,000 WSIs and diagnostic text pairs, spanning a wide range of diagnoses, procedure types, and tissue types. We present pathologist evaluation of text generation and text retrieval using WSI embeddings, as well as results for WSI classification and workflow prioritization (slide-level triaging). Model-generated text for WSIs was rated by pathologists as accurate, without clinically significant error or omission, for 78% of WSIs on average. This work demonstrates exciting potential capabilities for language-aligned WSI embeddings.

Training neural networks with high-quality pixel-level annotation in histopathology whole-slide images (WSI) is an expensive process due to gigapixel resolution of WSIs. However, recent advances in self-supervised learning have shown that highly descriptive image representations can be learned without the need for annotations. We investigate the application of the recent Hierarchical Image Pyramid Transformer (HIPT) model for the specific task of classification of colorectal biopsies and polyps. After evaluating the effectiveness of TCGA-learned features in the original HIPT model, we incorporate colon biopsy image information into HIPT's pretraining using two distinct strategies: (1) fine-tuning HIPT from the existing TCGA weights and (2) pretraining HIPT from random weight initialization. We compare the performance of these pretraining regimes on two colorectal biopsy classification tasks: binary and multiclass classification.

Prostate cancer diagnosis continues to encounter challenges, often due to imprecise needle placement in standard biopsies. Several control strategies have been developed to compensate for needle tip prediction inaccuracies, however none were compared against each other, and it is unclear whether any of them can be safely and universally applied in clinical settings. This paper compares the performance of two resolved-rate controllers, derived from a mechanics-based and a data-driven approach, for bevel-tip needle control using needle shape manipulation through a template. We demonstrate for a simulated 12-core biopsy procedure under model parameter uncertainty that the mechanics-based controller can better reach desired targets when only the final goal configuration is presented even with uncertainty on model parameters estimation, and that providing a feasible needle path is crucial in ensuring safe surgical outcomes when either controller is used for needle shape manipulation.

Soft electrohydraulic actuators known as HASEL actuators have attracted widespread research interest due to their outstanding dynamic performance and high output power. However, the displacement of electrohydraulic actuators usually declines with time under constant DC voltage, which hampers its prospective application. A mathematical model is firstly established to not only explain the decrease in displacement under DC voltage but also predict the relatively stable displacement with oscillation under AC square wave voltage. The mathematical model is validated since the actual displacement confirms the trend observed by our model. To smooth the displacement oscillation introduced by AC voltage, a serial elastic component is incorporated to form a SE-HASEL actuator. A feedback control with a proportion-integration algorithm enables the SE-HASEL actuator to eliminate the obstinate displacement hysteresis. Our results revealed that, through our methodology, the SE-HASEL actuator can give stable and smooth displacement and is capable of absorbing external impact disturbance simultaneously. A rotary joint based on the SE-HASEL actuator is developed to reflect its possibility to generate a common rotary motion for wide robotic applications. More importantly, this paper also proposes a highly accurate needle biopsy robot that can be utilized in MRI-guide surgical procedures. Overall, we have achieved AC-driven series elastic electrohydraulic actuators that can exhibit stable and smooth displacement output.