The robotic manipulator, designed by a team at the University of Bristol and based at the Bristol Robotics Laboratory, can apply very specific forces over a range similar to forces used by human examiners and can detect lumps using sensor technology at larger depths than before.
Graphic of clinical breast examination by robotic device. Image credit: George Jenkinson, University of Bristol
This robotic innovation could revolutionise how women monitor their breast health by giving them access to safe electronic CBEs in easily accessible places, such as pharmacies and health centres, which provide accurate results.
Precision, repeatability and accuracy are paramount in these tactile medical examinations to ensure favourable patient outcomes. A range of automatic and semi-automatic devices have been proposed to aid with optimising this task, particularly for difficult to detect and hard to reach situations such as during minimally invasive surgery.
Various stages of device examining fake breast. Image credit: George Jenkinson, University of Bristol
The research team included a mix of postgraduate and undergraduate researchers, supervised by Dr Antonia Tzemanaki from Bristol Robotics Laboratory. Lead author George Jenkinson explained: “There are conflicting ideas about how useful carrying out Clinical Breast Examinations (CBE) are for the population's health outcomes.
“It’s generally agreed upon that if it is well performed, it can be a very useful and low risk diagnostic technique.
“There have been a few attempts to use technology to improve the standard to which healthcare professionals can perform a CBE by having a robot or electronic device physically palpate breast tissue. But the last decade of technological advances in manipulation and sensor technology mean we are now in a better position to do this.
The device. Image credit: George Jenkinson, University of Bristol
“The first question that we want to answer as part of this is whether a specialised manipulator can be demonstrated to have the dexterity necessary to palpate a realistic breast size and shape.”
The team created their manipulator using 3D printing and other Computerised Numerical Control techniques and employed a combination of laboratory experiments and simulated experiments on a fake (silicone) breast and its digital twin, both modelled on a volunteer at the Simulation and Modelling in Medicine and Surgery research group at Imperial College London.
The simulations allowed the team to perform thousands of palpations and test lots of hypothetical scenarios such as calculating the difference in efficiency when using two, three, or four sensors at the same time. In the lab, they were able to carry out the experiments on the silicone breast to demonstrate the simulations were accurate and to discover the forces for the real equipment experimentally.
George added: “We hope that the research can contribute to and complement the arsenal of techniques used to diagnose breast cancer, and to generate a large amount of data associated with it that may be useful in trying to identify large scale trends that could help diagnose breast cancer early.
“One advantage that some doctors have mentioned anecdotally is that this could provide a low-risk way to objectively record health data. This could be used, for example, to compare successive examinations more easily, or as part of the information packet sent to a specialist if a patient is referred for further examination.”
As a next step, the team will combine CBE techniques learned from professionals with AI, and fully equip the manipulator with sensors to determine the effectiveness of the whole system at identifying potential cancer risks.
The ultimate goal is that the device and sensors will be able to detect lumps more accurately and deeper than possible only from applying human touch. It could also be combined with other existing techniques, such as ultrasound examination.
“So far we have laid all of the groundwork,” said George. “We have shown that our robotic system has the dexterity necessary to carry out a clinical breast examination – we hope that in the future this could help diagnose cancers early.”
Source: University of Bristol