Compact medical robot and methods of use thereof

Abstract

Systems and methods are disclosed in which a parallel kinematic robotic manipulator facilitates alignment of an insertable medical instrument according to an intraprocedurally-defined trajectory that is based on the identification, within volumetric image data, of a target location or region associated with a diagnostic procedure or therapeutic intervention. In some example implementations, a patient support is employed to provide access to an anatomical region, such as a pelvic region, and facilitate the placement of the parallel kinematic robotic manipulator in close proximity to the anatomical region, providing a compact configuration that enables intraprocedural imaging for target localization and registration of the frame of reference of the volumetric images with a frame of reference of the parallel kinematic robotic manipulator. In some example embodiments, the robotic system employs includes slider-based prismatically- driven parallel kinematic robotic manipulator, having a set of rails angled inwardly, with at least two carriages per rail.

Description

COMPACT MEDICAL ROBOT AND METHODS OF USE THEREOFCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Provisional Patent Application No. 63 / 730366, titled “COMPACT MEDICAL ROBOT” and filed on December 10, 2024, the entire contents of which are incorporated herein by reference, and to U.S. Provisional Patent Application No. 63 / 765308, titled “COMPACT MEDICAL ROBOT” and filed on February 28, 2025, the entire contents of which are incorporated herein by reference.BACKGROUND OF THE DISCLOSURE

[0002] The present disclosure relates to image-guided medical robots and in particular medical robots for use with image modalities such as image magnetic resonance imaging (MRI) systems, computed topography (CT) systems and the like.

[0003] The background herein is included solely to explain the context of the disclosure. This is not to be taken as an admission that any of the material referred to was published, known, or part of the common general knowledge as of the priority date.SUMMARY OF THE DISCLOSURE

[0004] Systems and methods are disclosed in which a parallel kinematic robotic manipulator facilitates alignment of an insertable medical instrument according to an intraprocedurally- defined trajectory that is based on the identification, within volumetric image data, of a target location or region associated with a diagnostic procedure or therapeutic intervention. In some example implementations, a patient support is employed to provide access to an anatomical region, such as a pelvic region, and facilitate the placement of the parallel kinematic robotic manipulator in close proximity to the anatomical region, providing a compact configuration that enables intraprocedural imaging for target localization and registration of the frame of reference of the volumetric images with a frame of reference of the parallel kinematic robotic manipulator. In some example embodiments, the robotic system employs includes slider-based prismatically- driven parallel kinematic robotic manipulator, having a set of rails angled inwardly, with at least two carriages per rail.

[0005] According to one aspect, there is provided a medical robotic system comprising: a patient support configured to support a patient such that an anatomical region of the patient is accessible; and a parallel kinematic robotic manipulator comprising: a base;a rigid structure; an end effector integrated with or attachable to the rigid structure, the end effector configured to facilitate insertion of a medical instrument along an insertion axis; a plurality of kinematic chains, each kinematic chain independently connecting the base to the rigid structure, wherein each kinematic chain comprises at least one link member and a plurality of joints, the plurality of joints including a distal rotational joint permitting angular movement between the kinematic chain and the rigid structure; and a drive system comprising a plurality of actuators, each actuator being operably coupled to a unique kinematic chain and independently controllable to actuate an active joint of the unique kinematic chain, the plurality of actuators being controllable to adjust a pose of the rigid structure relative to the base; the base being capable of mechanically docking with the patient support in a defined position and orientation for spatially registering the parallel kinematic robotic manipulator with the patient support; and the parallel kinematic robotic manipulator and the patient support being configured such that when the parallel kinematic robotic manipulator is docked with the patient support and the patient is supported by the patient support such that the anatomical region is accessible, the drive system is operable to achieve a pose of the rigid structure.

[0006] In another aspect, there is provided a parallel kinematic robotic manipulator comprising: a base having a rail system that includes at least a first elongate rail and a second elongate rail, each of the first and second elongate rails having a proximal end and a distal end opposite the proximal end; a rigid structure; an end effector integrated with or attachable to the rigid structure, the end effector being configured to facilitate insertion of a medical instrument along an insertion axis; a plurality of kinematic chains, each kinematic chain independently connecting the rail system of the base to the rigid structure, wherein each kinematic chain comprises at least one link and a plurality of joints, the plurality of joints including a distal rotational joint permitting angular movement between the kinematic chain and the rigid structure; and a drive system comprising a plurality of drive actuators, each drive actuator being operably coupled to a respective kinematic chain and controllable to actuate an active joint of the respective kinematic chain, the plurality of drive actuators being controllable to adjust a pose of the rigid structure relative to the base; wherein the first elongate rail and the second elongate rail extend generally along the same direction, but are oriented at a non-zero angle relative to one another such that aseparation distance between the proximal ends of the first and second elongate rails is greater than a separation distance between the distal ends of the first and second elongate rails, the first and second elongate rails thereby defining a V-shaped tapered rail footprint.

[0007] In another aspect, there is provided a method of preparing a medical robotic system for a medical procedure, the method comprising: providing the medical robotic system as described above; docking the parallel kinematic robotic manipulator with the patient support; supporting the patient with the patient support such that the anatomical region is accessible; while employing the patient support to support the patient, employing volumetric imaging system to obtain volumetric image data characterizing the anatomical region of the patient and one or more spatial features associated with the medical robotic system; identifying, in the volumetric image data, a target region within the anatomical region of the patient; employing the one or more spatial features to register a frame of reference of the volumetric image data with a frame of reference of the parallel kinematic robotic manipulator; employing the volumetric image data to define a trajectory, in a frame of reference of the parallel kinematic robotic manipulator, for insertion of the medical instrument into the patient, the trajectory intersecting the target region; determining a pose of the rigid structure for positioning and orienting the rigid structure such that the insertion axis of the end effector is aligned with the trajectory; and controlling the parallel kinematic robotic manipulator such that the rigid structure is positioned and oriented according to the determined pose.

[0008] A further understanding of the functional and advantageous aspects of the disclosure can be realized by reference to the following detailed description and drawings.BRIEF DESCRIPTION OF THE DRAWINGS

[0009] Embodiments are described with reference to the accompanying drawings. In the drawings, like reference numbers can indicate identical or functionally similar elements.

[0010] FIG. 1 is a schematic of an example robotic medical guidance system facilitating the controlled insertion of a medical instrument into a subject via an end effector supported by a parallel kinematic robotic manipulator having a trajectory defined based on volumetric images that are obtained intraoperatively via a volumetric imaging system.

[0011] FIG. 2 shows an example image-guided method of preparing a medical robotic system by controlling a parallel kinematic robotic manipulator to align an insertion axis of an endeffector along a trajectory that is intraprocedurally defined via volumetric images that are spatially registered to a frame of reference of the parallel kinematic robotic manipulator.

[0012] FIGS. 3A, 3B, 3C, 3D and 3E show an example patient support and its integration with the an example robotic system that includes a parallel kinematic robotic manipulator.

[0013] FIGS. 4A and 4B show alternative views of an example patient support and its integration with an image-guided medical robotic system.

[0014] FIG. 5 shows a top view of a patient supported on the patient support in a supine position, with the medical robotic system positioned between the articulated thighs of the patient.

[0015] FIG. 6A shows a schematic side view of an example embodiment of a parallel kinematic robotic manipulator that is a slider-based, prismatically driven parallel kinematic robotic manipulator with the parallel kinematic robotic manipulator positioned near a patient.

[0016] FIG. 6B shows a perspective view of another embodiment of a slider-based, prismatically driven parallel kinematic robotic manipulator positioned near a patient, where the robotic manipulator includes linear actuators supporting the rigid platform.

[0017] FIG. 6C shows a front view of the second embodiment of a slider-based, prismatically driven parallel kinematic robotic in FIG. 6B.

[0018] FIG. 6D shows a top schematic view of another embodiment of a slider-based, prismatically driven parallel kinematic robotic manipulator that includes a pair of spaced apart rails and four link members.

[0019] FIG. 6E shows a perspective view of an embodiment of the prismatically driven parallel kinematic robotic manipulator that is a Gough-Stewart prismatically driven parallel kinematic robotic manipulator positioned near a patient.

[0020] FIG. 6F shows a top schematic view of another embodiment of a slider-based, prismatically driven parallel kinematic robotic manipulator positioned near a patient, where the robotic manipulator includes a pair of spaced apart rails in a V-rail configuration and six link members.

[0021] FIG. 6G shows a top schematic view of another embodiment of a slider-based, prismatically driven parallel kinematic robotic manipulator, where the robotic manipulator includes proximal and distal sets of spaced apart rails in a V-rail configuration with six link members.

[0022] FIG. 6H shows a top schematic view of another embodiment of a slider-based, prismatically driven parallel kinematic robotic manipulator positioned near a patient, where the robotic manipulator includes a pair of spaced apart rails, a third rail positioned centrally between the pair of spaced apart rails and six link members with two of the link members connected to carriage assemblies on the third rail.

[0023] FIG. 61 shows a top schematic view of another embodiment of a slider-based, prismatically driven parallel kinematic robotic manipulator positioned near a patient, where the robotic manipulator includes six spaced apart, parallel rails with six link members and a single carriage assembly supported on each rail.

[0024] FIG. 7 is a schematic of an example robotic medical guidance system configured to employ intraoperative magnetic resonance imaging to define and confirm medical insertion trajectories.

[0025] FIG. 8 is a first portion of an expanded system overview of the system illustrated in FIG. 7.

[0026] FIG. 9 is a second portion of the expanded system overview of the system illustrated in FIG. 7.

[0027] FIG. 10 is a third portion of the expanded system overview of the system illustrated in FIG. 7.

[0028] FIGS. 11A and 11B are flow charts illustrating an example workflow for the use and control of a robot manipulator having a rigid structure with a needle guide for the MRI-assisted insertion of a medical instrument.

[0029] FIG. 12 is an isometric view of a robotic system for use with an MRI system and shown with a patient support on MRI table.

[0030] FIG. 13 is an isometric view of robot manipulator with enclosure and patient support.

[0031] FIG. 14A is an isometric view of robot manipulator with enclosure (without patient support).

[0032] FIG. 14B is an isometric view of robot manipulator similar to that shown in FIG. 14A but without enclosure.

[0033] FIG. 14C is a side view of robot manipulator shown in FIG. 14B.

[0034] FIG. 14D is a top view of robot manipulator shown in FIGS. 14B and 14C.

[0035] FIG. 14E is a rear view of robot manipulator shown in FIGS. 14B to 14D.

[0036] FIG. 14F is an exploded view of robot manipulator shown in FIGS. 14B to 14E.

[0037] FIG. 15A is a side view of robot manipulator without enclosure showing farthest pitch up.

[0038] FIG. 15B is a top view of robot manipulator without enclosure showing farthest yaw (left or right side).

[0039] FIG. 16A is anisometric view of robot manipulator similar to that shown in FIG. 14B but showing an alternate rail configuration wherein the angles of rails is parallel and showing an alternate shape for the rigid structure.

[0040] FIG. 16B is a top view of the robot manipulator shown in FIG. 16A.

[0041] FIG. 17A is an isometric view of a robot manipulator similar to that shown in FIG. 14A but showing different attachment points for the pivots.

[0042] FIG. 17B is a top view of the robot manipulator shown in FIG. 17A.

[0043] FIG. 18A is a first isometric view of carriage assembly of the robot manipulator of FIGS. 14A to 14F.

[0044] FIG. 18B is a second isometric view of the carriage assembly of FIG. 18A.

[0045] FIG. 18C is an exploded view of the carriage assembly of FIGS. 18A and 18B.

[0046] FIG. 18D is a side view of the carriage assembly of FIGS. 18Ato 18C.

[0047] FIG. 19A is an isometric view of an alternate carriage assembly having a sleeve bearing.

[0048] FIG. 19B is another alternative carriage assembly having a track roller.

[0049] FIG. 19C is a further carriage assembly having a ball bearing.

[0050] FIG. 20A is an isometric view of pivot ends used in the robot assembly of the robot manipulator of FIGS. 14Ato 14F.

[0051] FIG. 20B is a second isometric view of the pivot ends of FIG. 20A.

[0052] FIG. 20C is an exploded view of the pivot end of FIGS. 20A and 20B.

[0053] FIG. 20D is a sectional view of the pivot ends of FIGS. 20Ato 20C.

[0054] FIG. 21A is an isometric view of the robot manipulator similar to that shown in FIG. 14B but also showing the gradient pattern of the absolute encoder.

[0055] FIG. 21B is a sectional view of the robot manipulator showing the gradient pattern of the absolute encoder of FIG. 21 A.

[0056] FIG. 21 C is a front view of the absolute encoder gradient pattern shown in FIGS. 21 A and 21 B.

[0057] FIG. 22 is a flow diagram for the absolute encoders of FIGS. 21 A, 21 B and 21C.DETAILED DESCRIPTION OF THE EMBODIMENTS

[0058] Various embodiments and aspects of the disclosure will be described with reference to details discussed below. The following description and drawings are illustrative of the disclosure and are not to be construed as limiting the disclosure. Numerous specific details are described to provide a thorough understanding of various embodiments of the present disclosure.However, in certain instances, well-known or conventional details are not described in order to provide a concise discussion of embodiments of the present disclosure.

[0059] As used herein, the terms “comprises” and “comprising” are to be construed as being inclusive and open ended, and not exclusive. Specifically, when used in the specification and claims, the terms “comprises” and “comprising” and variations thereof mean the specifiedfeatures, steps or components are included. These terms are not to be interpreted to exclude the presence of other features, steps or components.

[0060] As used herein, the terms “about” and “approximately” are meant to cover variations that may exist in the upper and lower limits of the ranges of values, such as variations in properties, parameters, and dimensions. Unless otherwise specified, the terms “about” and “approximately” mean plus or minus 25 percent or less.

[0061] It is to be understood that unless otherwise specified, any specified range or group is as a shorthand way of referring to each and every member of a range or group individually, as well as each and every possible sub-range or sub-group encompassed therein and similarly with respect to any sub-ranges or sub-groups therein. Unless otherwise specified, the present disclosure relates to and explicitly incorporates each and every specific member and combination of sub-ranges or sub-groups.

[0062] As used herein, the term "on the order of', when used in conjunction with a quantity or parameter, refers to a range spanning approximately one tenth to ten times the stated quantity or parameter.

[0063] For the purpose of contextualizing the structure and operation of the systems, devices, and methods disclosed herein, headings are provided. The headings provided herein are for convenience only and do not interpret the scope or meaning of the claimed present technology. Embodiments under any one heading may be used in conjunction with embodiments under any other heading.

[0064] For simplicity and clarity of illustration, where considered appropriate, reference numerals may be repeated among the Figures to indicate corresponding or analogous elements. In addition, numerous specific details are set forth in order to provide a thorough understanding of the embodiment or embodiments described herein. However, it will be understood by those of ordinary skill in the art that the embodiments described herein may be practiced without these specific details. In other instances, well-known methods, procedures and components have not been described in detail so as not to obscure the embodiments described herein. It should be understood at the outset that, although exemplary embodiments are illustrated in the figures and described below, the principles of the present disclosure may be implemented using any number of techniques, whether currently known or not. The present disclosure should in no way be limited to the exemplary implementations and techniques illustrated in the drawings and described below.

[0065] Various terms used throughout the present description may be read and understood as follows, unless the context indicates otherwise: “or” as used throughout is inclusive, as though written “and / or”; singular articles and pronouns as used throughout include their plural forms, and vice versa; similarly, gendered pronouns include their counterpart pronouns so thatpronouns should not be understood as limiting anything described herein to use, implementation, performance, etc. by a single gender; “exemplary” should be understood as “illustrative” or “exemplifying” and not necessarily as “preferred” over other embodiments. Further definitions for terms may be set out herein; these may apply to prior and subsequent instances of those terms, as will be understood from a reading of the present description. It will also be noted that the use of the term “a” or “an” will be understood to denote “at least one” in all instances unless explicitly stated otherwise or unless it would be understood to be obvious that it must mean “one”.

[0066] Modifications, additions, or omissions may be made to the systems, apparatuses, and methods described herein without departing from the scope of the disclosure. For example, the components of the systems and apparatuses may be integrated or separated. Moreover, the operations of the systems and apparatuses disclosed herein may be performed by more, fewer, or other components and the methods described may include more, fewer, or other steps. Additionally, steps may be performed in any suitable order. As used in this document, “each” refers to each member of a set or each member of a subset of a set.

[0067] The embodiments described herein are exemplary (e.g., in terms of materials, shapes, dimensions, and constructional details) and do not limit the claims appended hereto and any amendments made thereto. Persons skilled in the art will appreciate that there are yet more alternative implementations and modifications possible, and that the following examples are only illustrations of one or more implementations.

[0068] As used herein the “operably connected” or “operably attached” means that the two elements are connected or attached either directly or indirectly including either directly or indirectly electrically or electronically connected. Accordingly, the items need not be directly connected or attached but may have other items connected or attached therebetween or the items may be virtually connected.

[0069] It is to be noted that the specification and claims of the application and the terms "first", "second" and the like in the drawings are used to distinguish similar objects, and do not need to describe a specific sequence or a precedence order. It will be appreciated that data used in such a way may be exchanged under appropriate conditions, in order that the embodiments of the application described here can be implemented in a sequence other than sequences graphically shown or described here. In addition, terms "include" and "have" and any variations thereof are intended to cover non-exclusive inclusions. For example, it is not limited for processes, methods, systems, products or devices containing a series of steps or modules or units to clearly list those steps or modules or units, and other steps or modules or units which are not clearly listed or are inherent to these processes, methods, products or devices may be included instead.

[0070] Unless defined otherwise, all technical and scientific terms used herein are intended to have the same meaning as commonly understood to one of ordinary skill in the art. Unless otherwise indicated, such as through context, as used herein, the following terms are intended to have the following meanings:

[0071] As used herein, the term “end effector” can refer to the terminal component or assembly of a robotic or mechanical manipulator, such as a component or interface that is configured to interact with the environment or perform a specific task. The term is intended to encompass both passive and actively controlled devices that serve as the operative interface between the robot manipulator and the instrument or target site.

[0072] As used herein, the term “workspace”, when referring to a robotic manipulator, refers to the set of all positions that the end effector can reach within its operational limits (a positional workspace). It is determined by the geometry of the mechanism, the range of motion of its joints, and any physical constraints. The workspace has an associate volume that is the three- dimensional region in space that encompasses all reachable positions of the end effector. It is often expressed as a spatial volume (e.g., cubic centimeters or cubic meters) and provides a quantitative measure of the reach of a robotic manipulator.

[0073] As used herein, the term “orientational workspace” refers to the range of orientations (rotations) that the end effector can achieve within its workspace under controlled articulation of a robotic manipulator. The orientational workspace is the set of all orientations that the end effector can achieve at each reachable position within its positional workspace. It is typically described in terms of allowable rotations about one or more axes, and may vary across the positional workspace.

[0074] The phrase “intraprocedural”, as used herein, refers to events, actions, or processes that occur in association with a medical procedure (e.g. diagnostic and / or therapeutic) before, during, or after an interventional step.

[0075] Conventional robotic systems for industrial and medical applications typically employ a serial robotic arm configuration consisting of a sequence of rigid links connected by actively controlled joints, most commonly rotational joints and occasionally prismatic joints for linear motion. Each joint is independently actuated, and the overall position and orientation of the end effector are determined by compounding the transformations of each link through forward kinematics. This architecture provides flexibility and a large reachable workspace, but its serial nature causes positioning errors accumulate along the chain.

[0076] Image-guided medical interventions rely on real-time visualization and navigation using imaging modalities such as fluoroscopy, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound, and the intraoperative use of this image data to locate and surgically access internal anatomical regions. Integrating conventional serial robotic arms withsuch imaging systems presents significant challenges. Operating rooms often impose tight spatial constraints, making it difficult to position and maneuver large articulated arms without obstructing the imaging field or surgical access. Furthermore, accurate intervention requires precise spatial registration between the robot and the imaging system, which can be complex and error-prone. MRI-guided procedures introduce additional hurdles as the strong magnetic fields necessitate the use of MR-safe materials and non-ferromagnetic components, and electronic actuators must be carefully shielded or replaced with alternative drive mechanisms to avoid interference. These factors collectively complicate the adaptation of traditional robotic arms for advanced image-guided surgical applications.

[0077] Image-guided procedures that involve the precise insertion of medical instruments or devices at intraoperatively identified targets can place high demands on the accuracy and stability of the robotic end effector’s pose. The robot must not only achieve the correct position and orientation but also maintain or facilitate a controlled trajectory for insertion of the instrument to ensure that the distal tip reaches the target identified by the imaging system. Conventional serial-link robotic arms can be problematic in this context due to the difficulty of controlling and reliably knowing the absolute pose of the end effector, as small errors in joint angles accumulate along the kinematic chain. This compounded uncertainty affects both the trajectory of the instrument and the final location of its distal end, making it challenging to achieve the level of precision and accuracy required for safe and effective image-guided interventions.

[0078] In addition to being bulky and often incompatible with imaging systems used in image- guided procedures, conventional medical robotic platforms can be prohibitively expensive to deploy in standard imaging suites such as MRI or CT rooms. Their size and complexity typically require dedicated operating environments, making them impractical for integration into existing imaging facilities. This cost barrier is even more pronounced for small and medium-sized hospitals, which could otherwise benefit from robotic assistance in image-guided interventions but cannot justify the investment in a full-scale medical robotic system.

[0079] Recognizing these limitations, the present inventors set out to develop an alternative robotic configuration that would overcome these challenges. Their goal was to create a system that is capable of delivering high accuracy and precision, adaptable for use within imaging environments including insertion into an MRI or CT gantry, while avoiding the drawbacks of complex serial-link architectures prone to cumulative errors. It was determined that a solution would be compact and positionable for accessing different anatomical regions of a patient, yet sufficiently streamlined to fit within the spatial constraints of imaging systems. Furthermore, it was deemed that an improved robotic system should be cost-effective, reducing or eliminatingthe need for the substantial capital investment associated with conventional medical robotic platforms, and enabling broader adoption across diverse clinical settings.

[0080] To address these needs, the present disclosure provides improved robotic systems based on a parallel kinematic robotic architecture, representing a significant departure from the conventional serial-link paradigm employed in medical robotics. A parallel kinematic robotic manipulator is a robotic system that includes a rigid structure that is operatively connected to a fixed base, and which has a pose that is controllable relative to the fixed base by movement of a set of kinematic chains arranged in parallel. The phrase “arranged in parallel” means that each kinematic chain independently connects the fixed base to the rigid structure, such that the kinematic chains cooperate to control the pose of the rigid structure rather than being connected in series. Each kinematic chain of a parallel kinematic robotic manipulator includes at least one link member and a set of joints, where the set of joints includes a rotational joint that permits relative angular movement between the kinematic chain and the rigid structure. Each kinematic chain also includes an active joint that is actuated by a respective actuator, such that the coordinated actuation of the actuators enables, via controlled articulation of the kinematic chains, controlled motion of the rigid structure in at least three degrees of freedom, and in some embodiments five or six degrees of freedom, for adjusting a pose of the rigid structure in a controlled manner.

[0081] Accordingly, unlike serial manipulators, which rely on a chain of sequential joints and links, parallel kinematic robotic manipulators employ multiple actuated limbs arranged in parallel to support and position a common rigid structure, which typically has an end effector attached or attachable thereto. The parallel structure of a parallel kinematic robotic manipulator inherently provides higher stiffness, improved load distribution, and reduced cumulative error, enabling superior accuracy and repeatability in positioning.

[0082] As will be shown below, medical robotic systems can be adapted to employ the compact geometry of parallel kinematic robotic manipulators to allow the system to be configured for insertion into imaging gantries, and can in some implementations provide unobstructed or only partially obstructed access to the patient. Additionally, parallel kinematic robotic manipulators can be designed employing MR-compatible materials, configurations and actuation strategies, facilitating compatibility with MR environments. Accordingly, as will be described in the example embodiments presented below, medical robotic systems that employ a parallel kinematic robotic manipulator design can be adapted to provide a compact and cost- effective solution that with the precision, accuracy, adaptability to many different image-guided procedures involving different anatomical regions and / or treatments, particularly in settings where conventional robotic systems are impractical.

[0083] As will be explained in detail below, parallel kinematic robotic manipulators can take on many different forms, while still maintaining the aforementioned design and benefits. One example of a parallel kinematic robotic manipulator is a prismatically driven parallel kinematic robotic manipulator, where each kinematic chain includes at least one prismatic joint that is driven by a respective actuator, and where all rotational joints within each kinematic chain are passive joints, such as spherical or universal joints, that facilitate orientation flexibility without actuation.

[0084] One example of a parallel kinematic robotic manipulator is known as the Gough-Stewart prismatically driven parallel kinematic robotic manipulator, for which each kinematic chain is connected to the base through a respective proximal passive rotational joint (e.g., spherical or universal joint) that is fixed in location on the base. Each kinematic chain of a Gough-Stewart prismatically driven parallel kinematic robotic manipulator includes a linkage that includes two uniaxial link members connected by an actuated prismatic joint that controls the length of the linkage, with each kinematic chain being connected to the distal rigid structure through respective distal passive rotational joint (e.g., spherical or universal joint). The pose of the rigid structure is controlled via actuation of the prismatic joints to vary the length of the linkage of each kinematic chain. In some example implementations, the Gough-Stewart prismatically driven parallel kinematic robotic manipulator includes six kinematic chains, where coordinated actuation of the six prismatic joints enables controlled motion of the distal rigid structure in six degrees of freedom. In other example implementations, a Gough-Stewart prismatically driven parallel kinematic robotic manipulator can include fewer than six kinematic chains, resulting a reduction in degrees of freedom.

[0085] Another example of a parallel kinematic robotic manipulator that also employs active prismatic joints is referred to herein as a “slider-based prismatically driven parallel kinematic robotic manipulator”, for which each kinematic chain includes a link member having a fixed length that is connected, at its distal end (furthest from the base), to the rigid structure through a distal passive spherical joint, and is connected, at its proximal end (closest to the base), to a movable carriage through a proximal passive spherical joint. The base includes a plurality of spaced-apart rails, where each movable carriage is connected to and slidably moveable along a given rail via an actuated prismatic joint of the moveable carriage that drives the sliding motion of the movable carriage along the rail. In the example case of a slider-based prismatically driven parallel kinematic robotic manipulator, the pose of the rigid structure is controlled via actuation of the prismatic joints that connect the movable carriages to the rails. In some example implementations, the base includes a dedicated rail for each carriage, such that each carriage is connected, through a respective prismatic joint, to a different rail. In other example implementations, more than one carriage can be connected and slidably moveable along acommon rail. In some example implementations, slider-based prismatically driven parallel kinematic robotic manipulator includes six kinematic chains, where coordinated actuation of the six prismatic joints enables controlled motion of the distal rigid structure in six degrees of freedom. In other example implementations, a slider-based prismatically driven parallel kinematic robotic manipulator can include fewer than six kinematic chains.

[0086] One common attribute of the example parallel kinematic robotic manipulator configurations described above, and described and illustrated in detail below, is the limited workspace (workspace volume), and limited orientational workspace (the combination of the workspace volume and the range of orientations achievable at every location within the volume) associated with such robotic systems. However, these limitations can actually be advantageous for applications involving image guided medical (e.g. surgical) procedures. Indeed, the smaller workspace of a parallel kinematic robotic manipulator, which is typically more constrained compared to serial robotic arm manipulators, can be a good match with the confined environments such as imaging gantries. In other words, the limited workspace volume of a parallel kinematic robotic manipulator can be tailored to be a suitable operative fit with the limited accessible volume with the bore of an imaging system, such as a magnetic resonance or computed tomography gantry bore. Furthrmoe, as noted above, the spatial constraints associated with a parallel kinematic robotic manipulator can advantageously result in improved control over end effector pose with more rigidity, precision and accuracy than conventional serial-linkage-based robotic arms. While the orientational workspace of a parallel kinematic robotic manipulator is also typically limited compared to a serial-linkage-based robotic arm, the reduced orientational workspace is often sufficient fortasks that require precise alignment of an insertion axis, rather than the broad angular flexibility that may be needed for procedures that do not rely on image guidance. Accordingly, the tasks involved in image-guided procedures that involve manipulation in confined spaces can benefit from the precise control of position and orientation of parallel kinematic robotic manipulators systems, making them an excellent choice for achieving high accuracy and stability within the imposed spatial constraints.

[0087] Many example embodiments of the present disclosure disclose systems and methods in which a parallel kinematic robotic manipulator is employed to facilitate the insertion of an elongate medical tool, instrument or device into a subject, according to an intraprocedurally- defined trajectory that is defined based on the intraprocedural identification, within volumetric image data, of a target location or region associated with a diagnostic procedure or therapeutic intervention. As demonstrated above, there are many different types of parallel kinematic robotic manipulators that can be implemented in such embodiments, each offering unique structural and functional characteristics. These include configurations such as Stewartplatforms, and other closed-loop architectures that differ in the arrangement of actuated limbs and the degrees of freedom provided.

[0088] In the following sections, select example implementations will be described in detail and illustrated, with the understanding that these examples are not intended to be limiting but rather to demonstrate representative embodiments of the invention. Building on these examples, the following disclosure will also explore the beneficial use of parallel kinematic robotic manipulators for various workflows involving image-guided medical procedures. Such workflows include tasks requiring precise instrument positioning, controlled trajectories, and compatibility with imaging environments such as MRI and CT, where the advantages of parallel architectures, including compactness, stiffness, and accuracy, can be employed to overcome the limitations of conventional serial robotic systems.Example System for Guided Insertion of Medical Instruments

[0089] Referring to FIG. 1 , a block diagram is shown illustrating an example implementation of a medical robotic guidance system that facilitates the controlled insertion of a medical instrument into a subject, along a selected trajectory, via an end effector 30 having a pose that is adjustable by a parallel kinematic robotic manipulator 10, where the pose of the end effector 30 is defined and controlled, based on the planned trajectory and registration with the patient anatomy via volumetric image data 170 obtained intraoperatively via a volumetric imaging system 190.

[0090] The parallel kinematic robotic manipulator 10 includes a base 15, a rigid structure 20 (e.g. a platform or rigid assembly), and a parallel set of kinematic chains 25, each kinematic chain independently connecting the base to the rigid structure. Each kinematic chain includes at least one link member and a set of joints (not shown in FIG. 1 , but described and illustrated in detail below for various example types of parallel kinematic robotic manipulators), where the joints include a distal rotational joint permitting angular movement between the kinematic chain 25 and the rigid structure 20. The parallel kinematic robotic manipulator 10 includes an end effector 30 that is integrated with or attachable to the rigid structure 20. The end effector 30 is configured to facilitate insertion of a medical instrument 50 along an insertion axis 55.The parallel kinematic robotic manipulator 10 includes actuators that are operably connected to motor drivers 180 to vary the articulation of the parallel kinematic robotic manipulator 10, and encoders that facilitate the determination (measurement / detection) of the pose of the moveable rigid structure 20 (e.g. distal articulating platform) of the parallel kinematic robotic manipulator. As described in detail below, in some example embodiments, each kinematic chain of the parallel kinematic robotic manipulator includes a respective absolute encoder that facilitates an absolute determination of the pose of the rigid structure.

[0091] FIG. 1 illustrates an example case in which the end effector 30 is a guide structure that defines a prescribed insertion axis 55 (e.g. guide axis) for guiding an elongate medical instrument 50, such as a biopsy needle or focal therapeutic device. As shown in the figure, the end effector orients an elongate axis of the insertable medical instrument 50 along a corresponding guide axis 55 of the end effector. In this present example, the end effector 30 thus serves to stabilize the medical instrument in a fixed orientation relative to the parallel kinematic robotic manipulator, such that the guide structure can be employed to mechanically guide (in a manual or autonomous manner) the controlled insertion of the medical instrument into tissue along a predefined trajectory, where the robotic manipulator provides controlled actuation and to position the guide structure such that the elongate (e.g. operative) axis of the medical instrument is aligned with the predefined trajectory. An example of an end effector configured as a guide structure is a needle guide assembly that is rigidly and optionally removably docked to the rigid structure 20 of the parallel kinematic robotic manipulator in a fixed position and orientation.

[0092] It will be understood that FIG. 1 illustrates a non-limiting example of an end effector 30, in which the end effector 30 is a guide structure, for example, a structure defining an elongate conduit, for guiding the insertion (e.g. manual insertion) of a medical instrument along an insertion axis 55. In other example embodiments, the end effector 30 can be a medical instrument that is secured to the rigid base, for example, via an instrument support structure, where medical instrument has an elongate distal portion that is insertable into the patient, and which has an associated insertion axis. In such cases, the parallel kinematic robotic manipulator can be robotically controlled to drive the insertion of the insertable portion of the medical device into the patient, along a defined trajectory determined based on the identification of a target in the volumetric image data 170.

[0093] It will also be understood that a wide range of medical instruments, tools, devices and implants can be integrated with the rigid support of the parallel kinematic robotic manipulator to form the end effector, or can be guided by an end effector of the parallel kinematic robotic manipulator. While the present disclosure includes several examples of such medical instruments, tools and devices, it will be understood that the disclosure is not intended to be limited to the examples provided. Non-limiting examples of medical instruments that include at least an elongate distal portion, defining an insertion axis, and which are insertable into a patient for performing a diagnostic, therapeutic, or combined diagnostic and therapeutic procedure or intervention, include instruments for access and guidance, such as introducer sheaths, cannulas, guidewires, and trocars; diagnostic instruments, including biopsy needles, aspiration needles, and endoscopic or laparoscopic scopes; therapeutic instruments, such as ablation probes (e.g., radiofrequency, microwave, cryoablation), drainage catheters, andinfusion cannulas; energy-delivery and powered surgical instruments, including electrosurgical devices, ultrasonic dissection tools, laser delivery fibers; and specialized interventional tools, such as electrophysiology catheters, powered bone-cutting or drilling instruments.

[0094] As illustrated in the figure, the base 15 of the parallel kinematic robotic manipulator mechanically docks with a patient support 40. The patient support 40 is configured to support at least a portion of the body of the patient such that an anatomical region, into which the medical instrument is to be inserted is accessible by the parallel kinematic robotic manipulator. The docking of the base 15 with the patient support 40 occurs in a prescribed mechanical configuration, based on mechanical docking features present in at least one of the base 15 and the patient support 40 (examples of which are described below), which facilitate spatial registration of the parallel kinematic robotic manipulator with the patient support 40. While many of the example embodiments described herein pertain to the incorporation of a patient support that provides access to a pelvic region for pelvic procedures such as, but not limited to, prostate biopsies and therapeutic interventions involving treatment of pathologies of the prostate, it will be understood that the present disclosure is not intended to be limited to pelvic procedures or procedures involving the prostate, and examples of other types of patient supports that provide access to other anatomical regions are described below.

[0095] The patient support and the parallel kinematic robotic manipulator are mechanically and spatially configured (constrained) such that the patient support, with the parallel kinematic robotic manipulator docked thereto and the patient supported thereon, with the anatomical region accessible via actuation of the parallel kinematic robotic manipulator, can be translated relative to an imaging system for the acquisition of medical images before, during or after a procedure involving the insertion of an insertable medical device. For example, the patient support can be configured to be secured or securable to a couch or table of a volumetric imaging system, and the patient support and the parallel kinematic robotic manipulator are sized to permit insertion of the patient such that the anatomical region that is accessible via the patient support, and into which the medical instrument is to be inserted to perform the medical procedure, resides within an imaging volume (volume or region where image data can be acquired) of the imaging system.

[0096] Various types of volumetric imaging systems can be employed intraprocedurally to acquire image data for identifying a target anatomical structure and / or confirming accurate placement of an insertable medical device. Such imaging modalities may include, without limitation, a computed tomography (CT), a magnetic resonance imaging (MRI) system, an ultrasound-based volumetric imaging system, an optical coherence tomography (OCT) system, and a positron emission tomography (PET) system. It will be appreciated that the imaging system may be a wide variety of different imaging systems. While some examples of imagingsystems can be gantry-based and include an imaging bore, other imaging systems need not include a gantry. As shown in the figure, the image data acquired from such imaging systems is accessible by the control and processing circuitry 100, enabling the determination of a suitable trajectory, based on an identified target, for the controlled alignment of an insertion axis of an insertable medical device, via the control of the pose of the end effector of the parallel kinematic robotic manipulator. By leveraging volumetric imaging feedback, the parallel kinematic robotic manipulator can adjust its articulation to ensure trajectory accuracy and optimal device insertion and placement within the patient anatomy.

[0097] The intraprocedural use of the volumetric image data (e.g. for target identification and trajectory determination) is facilitated by registration between a frame of reference of the volumetric image data and a frame of reference of the parallel kinematic robotic manipulator (i.e. permitting the determination of a coordinate transformation between the two frames of reference). This registration can be achieved by known positional and orientational relationships between the volumetric imaging system and the parallel kinematic robotic manipulator.

[0098] For example, as noted above, in example implementations in which the parallel kinematic robotic manipulator is mechanically docked in a fixed position and orientation relative to the patient support, the patient support can include one or more features that reside within an imaging volume of the volumetric imaging system during the intraprocedural acquisition of volumetric image data characterizing the patient anatomy, where the features are identifiable within the acquired volumetric image data. The locations of the features within the volumetric images can be employed, based on known locations of the features (e.g. within a model of the patient support), and based on known mechanical registration between the patient support and the parallel kinematic robotic manipulator, to determine a coordinate transformation between a reference frame of the volumetric image data and a frame of reference of the parallel kinematic robotic manipulator. In some example implementations, one or more of the features can be inherent mechanical features of the patient support, provided that they are identifiable within the volumetric images. In some example implementations, one or more of the features can be fiducial markers integrated into the patient support that are identifiable within the volumetric images, such as the example fiducial markers shown at 60 in FIG. 1.

[0099] In example implementations in which at least a portion of the parallel kinematic robotic manipulator resides within the imaging volume of the volumetric imaging system during the acquisition of intraprocedural volumetric images characterizing the anatomical region, the parallel kinematic robotic manipulator can include one or more features that reside within the imaging volume of the volumetric imaging system during the intraprocedural acquisition of volumetric image data characterizing the patient anatomy, where the features are identifiable within the acquired volumetric image data. The locations of the features within the volumetricimages can be employed, based on known locations of the features (e.g. within a model of the parallel kinematic robotic manipulator) to determine a coordinate transformation between a reference frame of the volumetric image data and a frame of reference of the parallel kinematic robotic manipulator. In some example implementations, one or more of the features of the parallel kinematic robotic manipulator can be inherent mechanical features of the patient support, provided that they are identifiable within the volumetric images. In some example implementations, one or more of the features can be fiducial markers integrated into the parallel kinematic robotic manipulator that are identifiable within the volumetric images.

[0100] The example robotic system can thus be employed or adapted for an image-guided workflow that leverages (i) the registration between the frame of reference of the volumetric imaging system and the frame of reference of the parallel kinematic robotic manipulator, and (ii) the support of the anatomical region of the patient, by the patient support, such that the anatomical region remains in a constant position and orientation relative to the parallel kinematic robotic manipulator, during and after intermittent volumetric imaging steps, to facilitate alignment of the insertion axis of the end effector of the parallel kinematic robotic manipulator with a trajectory that is defined based on intraprocedurally-acquired volumetric image data and is transformed into the frame of reference of the parallel kinematic robotic manipulator. These spatial relationships enable a hybrid image guided workflow in which some aspects of the procedure, such as, for example, the step of insertion of the medical instrument into the patient, can be performed with the anatomical region moved outside of the imaging volume of the volumetric imaging system, but where the trajectory for guided or autonomous insertion is defined based on an initial intraprocedural imaging step, and is mapped into a frame of reference of the parallel kinematic robotic manipulator that is co-moving with the parallel kinematic robotic manipulator and the patient, via imaged-based and mechanical registration, even when the anatomical region of the patient is removed from the imaging volume. Moreover, in some example methods, the accuracy of placement of the insertable medical instrument into the patient can be verified by a subsequent intraprocedural imaging step.

[0101] Referring again to FIG. 1 , the control and processing hardware 100 is operably connected to the motor drivers 180 that control actuation and articulation of the parallel kinematic robotic manipulator 10. The control and processing hardware 100, which includes one or more processors 110 (for example, a CPU / microprocessor), bus 105, memory 115, which may include random access memory (RAM) and / or read only memory (ROM), a data acquisition interface 120, a display 125, external storage 130, one more communications interfaces 135, a power supply 140, and one or more input / output devices and / or interfaces 145 (e.g. a speaker, a user input device, such as a keyboard, a keypad, a mouse, a position tracked stylus, a position tracked probe, a foot switch, and / or a microphone for capturing speechcommands). Volumetric image data 170 and instrument registration data 175 may be stored on an external database or stored in memory 115 or storage 130 of control and processing hardware 100.

[0102] The control and processing hardware 100 may be programmed with programs, subroutines, applications or modules 150, which include executable instructions, which when executed by the one or more processors 110, causes the system to perform one or more methods described in the present disclosure. The example illustrated modules, which are not intended to be limiting, include: (i) a robot registration module 152 that employs known locations of fiducials 14 and detected locations of the fiducials in the acquired volumetric image data 190 to spatially register the reference frame of the parallel kinematic robotic manipulator, and that of the needle guide assembly 10, to the reference frame of the patient anatomy (the volumetric image data), based in part on known articulated pose of the parallel kinematic robotic manipulator that is measurable from encoders, and which employs the instrument calibration to enabling the determination of a suitable pose of the parallel kinematic robotic manipulator such that that a medical instrument is guided along a desired trajectory; (ii) a target selection module 154 that enables an operator to select one or more targets in the volumetric image data for performing an intervention; (iii) a trajectory analysis and selection module 156 enabling the determination of a suitable trajectory for insertion of an interventional instrument to perform an intervention at the one or more targets; (iv) a parallel kinematic parallel kinematic robotic manipulator control module 158 to facilitate user-controlled (human-in-the-loop) actuation of the parallel kinematic robotic manipulator to achieve a calculated pose, for example to align the insertion axis of the end effector along a prescribed trajectory; and (v) a navigation image module 160 that presents the user with navigation images based on intraoperatively acquired volumetric image data to confirm proper insertion of the interventional instrument.

[0103] As described above, in many of the example embodiments disclosed herein in which an end effector is configured to support and / or guide insertion of an insertable medical instrument, the location of the insertion axis of the end effector, relative to the rigid support 20, can vary due to an instrument-specific (in the case when different medical instruments can be removably secured to the rigid structure, optionally via a removably attachable instrument support structure) or end-effector-specific (in the case when different end effectors can be removably secured to the rigid structure) lateral axis offset that is dependent, for example, on the size of the medical instrument. To accommodate and calibrate for this variation (lateral axis offset), instrument registration data 175 can be pre-defined and stored or otherwise provided to the control and processing system 100, and can associate a specific calibration offset (axial correction) for each instrument of a set of instruments. Prior to the system determining a pose for articulating the parallel kinematic robotic manipulator for a given procedure involving theinsertion of a selected medical instrument along a prescribed trajectory, the user can select (identify), for example, via input provided on a user interface or other suitable input device, the medical instrument that is to be inserted. The control and processing system 100 can then determine, based on the instrument registration data, a suitable lateral offset correction to employ when calculating a pose for aligning the parallel kinematic robotic manipulator for the insertion of the interventional instrument along a planned trajectory.

[0104] Although only one of each component is illustrated in FIG. 1 , any number of each component can be included in the control and processing hardware 100. For example, a computer typically contains a number of different data storage media. Furthermore, although bus 105 is depicted as a single connection between all of the components, it will be appreciated that the bus 105 may represent one or more circuits, devices or communication channels which link two or more of the components. For example, in personal computers, bus 105 often includes or is a motherboard. Control and processing hardware 100 may include many more or less components than those shown. Moreover, in some example implementations, one or more components of the control and processing subsystem may reside on separate physical devices or components (and optionally in different locations), for example, as illustrated in example expanded system in FIGS. 8-10 in which computing / processing are included many subcomponents residing in different rooms of an MRI scanning system.

[0105] The control and processing hardware 100 may be implemented as one or more physical devices that are coupled to processor 110 through one of more communications channels or interfaces. For example, control and processing hardware 100 can be implemented using application specific integrated circuits (ASICs). Alternatively, control and processing hardware 100 can be implemented as a combination of hardware and software, where the software is loaded into the processor from the memory or over a network connection.

[0106] Some aspects of the present disclosure can be embodied, at least in part, in software, which, when executed on a computing system, transforms a computing system into a specialty-purpose computing system that is capable of performing the methods disclosed herein. That is, the techniques can be carried out in a computer system or other data processing system in response to its processor, such as a microprocessor, executing sequences of instructions contained in a memory, such as ROM, volatile RAM, non-volatile memory, cache, magnetic and optical disks, or a remote storage device. Further, the instructions can be downloaded into a computing device over a data network in a form of compiled and linked version. Alternatively, the logic to perform the processes as discussed above could be implemented in additional computer and / or machine readable media, such as discrete hardware components as large-scale integrated circuits (LSI's), application-specificintegrated circuits (ASIC's), or firmware such as electrically erasable programmable read-only memory (EEPROM's) and field-programmable gate arrays (FPGAs).

[0107] A computer readable medium can be used to store software and data which when executed by a data processing system causes the system to perform various methods. The executable software and data can be stored in various places including for example ROM, volatile RAM, non-volatile memory and / or cache. Portions of this software and / or data can be stored in any one of these storage devices. In general, a machine readable medium includes any mechanism that provides (i.e., stores and / or transmits) information in a form accessible by a machine (e.g., a computer, network device, personal digital assistant, manufacturing tool, any device with a set of one or more processors, etc.).

[0108] Examples of computer-readable media include but are not limited to recordable and non-recordable type media such as volatile and non-volatile memory devices, read only memory (ROM), random access memory (RAM), flash memory devices, floppy and other removable disks, magnetic disk storage media, optical storage media (e.g., compact discs (CDs), digital versatile disks (DVDs), etc.), among others. The instructions can be embodied in digital and analog communication links for electrical, optical, acoustical or other forms of propagated signals, such as carrier waves, infrared signals, digital signals, and the like. As used herein, the phrases “computer readable material” and “computer readable storage medium” refer to all computer-readable media, except for a transitory propagating signal perse.

[0109] It will be understood that the present example is illustrative and is not intended to limit the scope of the present disclosure to any particular configuration, material, or clinical application. Variations in guide design, architecture and configuration of the robotic manipulator (including the number of degrees of freedom of actuation), and of the instrument type, may be employed without departing from the intended scope of the present disclosure.Example Workflows for Guided Insertion of Medical Instruments

[0110] As explained above, as a result of the registration between the frame of reference of the volumetric imaging system and the parallel kinematic robotic manipulator, and the support of the patient on a patient support that provides access to the anatomy region of the patient and supports the patient such that the patient anatomy remains in a constant position and orientation relative to the parallel kinematic robotic manipulator, even during and after intermittent volumetric imaging steps during which the anatomic region is moved into and out of an imaging volume of the volumetric imaging system, the medical robotic system is adapted for an image-guided workflow that employs an imaging system to (i) intraprocedurally locate an internal target with an anatomical region, (ii) define a trajectory for accessing the target via insertion of a medical instrument, and (iii) perform registration between a frame of reference ofthe parallel kinematic robotic manipulator and a frame of reference of the imaging system, which facilitates the control the parallel kinematic robotic manipulator to align the end effector such that an insertion axis of the end effector is aligned with the trajectory. Various example embodiments and adaptations of such workflows are described in detail below.

[0111] FIG. 2 provides a flow chart illustrating an example image-guided method for preparing the robotic system shown in FIG. 1 such that the end effector is articulated in a pose suitable for insertion of a medical instrument along a trajectory that is determined via an intraprocedural volumetric imaging step. The robotic system is configured such that the parallel kinematic robotic manipulator is docked with the patient support, as shown in FIG. 1 , and the patient is supported by the patient support such that the anatomical region that is to be imaged, and into which the medical instrument is to be inserted, is accessible by the parallel kinematic robotic manipulator, as indicated in step 200 of FIG. 2. Example patient supports for performing this step within the context of pelvic medical procedures are described in the following sections of the present disclosure. This initial step can be performed with the patient support and the parallel kinematic robotic manipulator outside of the imaging volume of the imaging system.

[0112] As shown at step 210, while employing the patient support to support the patient, the volumetric imaging system is employed to obtain volumetric image data characterizing the anatomical region of the patient. For example, the patient support, with the docked parallel kinematic robotic manipulator and the patient, can be translated into the imaging volume of the volumetric imaging system (e.g. within the bore of an MR or CT imaging system). Moreover, as also shown in step 210, the patient support and the parallel kinematic robotic manipulator are spatially configured and located in proximity to the anatomical region of interest such that one or more spatial features, such as fiducial markers or structural features detectable by the imaging modality, reside in the imaging volume and are also present in the acquired volumetric image data.

[0113] As per step 220, the volumetric image data is processed to define a target region within the anatomical region of the patient. For example, the volumetric image data can be processed to render one or more images on user interface or display, and a user or clinical can select the appropriate target region. The volumetric image data is also processed, as shown at step 230, to employ the one or more spatial features to register a frame of reference of the volumetric image data with a frame of reference of the parallel kinematic robotic manipulator. For example, the known spatial locations of the spatial features can be employed to locate the position and orientation of the parallel kinematic robotic manipulator, thereby enabling the determination of a coordinate transformation between the frame of reference of the volumetric image data with the frame of reference of the parallel kinematic robotic manipulator.

[0114] Having performed registration between the parallel kinematic robotic manipulator and the volumetric image data, the volumetric image data can be employed to define a trajectory, in a frame of reference of the parallel kinematic robotic manipulator, for insertion of the medical instrument into the patient, such that the trajectory intersects the target region, as shown at step 240. This can be performed, for example, in an autonomous manner, based on the selection of a trajectory that is accessible within an orientation workspace of the parallel kinematic robotic manipulator. In some example embodiments, one or more candidate trajectories, such as trajectories having been validated to be accessible within the orientation workspace of the parallel kinematic robotic manipulator, can be presented or selectable by a user on a user interface (e.g. a user interface of a navigation display system).

[0115] Having determined the trajectory within the frame of reference of the parallel kinematic robotic manipulator, known inverse kinematic relationships governing the articulation of the parallel kinematic robotic manipulator can be employed to determine a pose of the rigid structure for positioning and orienting the rigid structure (or equivalently, positioning and orienting the end effector that is rigidly integrated with or attached to the rigid structure), such that the insertion axis of the end effector is aligned with the trajectory, as shown at step 250. As indicated in step 260, the parallel kinematic robotic manipulator, having integrated encoders that encode (in some embodiments, absolute encoding) the articulation of the kinematic chains such that pose of the rigid structure is known, is controlled such that the rigid structure is positioned and oriented according to the determined pose.

[0116] Having positioned and oriented the end effector with a pose such that the insertion axis is aligned with the trajectory, the medical instrument can be inserted into the patient, which can be performed, according to various example embodiments, manually or under controlled actuation of the parallel kinematic robotic manipulator.

[0117] In example embodiments in which the end effector is a guide structure that defines a guide axis for the manual insertion of a medical instrument, an indication can be provided to the user of an appropriate depth of insertion relative to the target based on a known distance between a reference location associated with the end effector and the target, as both of these locations are known in the frame of reference of the parallel kinematic robotic manipulator. For example, the system can calculate the distance between one or more known reference markings and / or structural stops on the end effector, and instruct the user to insert the insertable instrument to a prescribed depth, for example, relative to a known reference location on the insertable medical device. For example, the insertable medical instrument and / or the end effector can have markings along an axis thereof that can be employed insert the insertable medical instrument to a prescribed depth of insertion. Alternatively, a structural stop can be secured to the medical instrument to prevent insertion beyond a prescribed depth viaengagement with a corresponding surface or protrusion on the end effector, where the location of the structural stop can be prescribed based on the computed depth of insertion.

[0118] In some example embodiments, all of the steps shown in FIG. 2 can be performed with the anatomical region of the patient, into which the medical instrument is to be inserted, positioned within the imaging volume of the volumetric imaging system. For example, these steps can be performed “in bore” of an imaging gantry such as a magnetic resonance imaging system. However, in view of the spatial registration that is achieved between the frame of reference of the parallel kinematic robotic manipulator and the frame of reference of the volumetric imaging system, while step 210 relies on the positioning of the anatomical region within the imaging volume for the acquisition of image data and the identification of the target location, any of the remaining steps can be performed with the patient and the parallel kinematic robotic manipulator withdrawn from the imaging volume of the volumetric imaging system.

[0119] Furthermore, in some example implementations, the step of insertion of the medical instrument into the patient anatomy, along an insertion axis of the end effector that is aligned with the trajectory, can be performed in the absence of direct, real-time image guidance, i.e. without requiring direct image-guided insertion of the medical instrument, with the patient and the parallel kinematic robotic manipulator withdrawn from the imaging volume of the volumetric imaging system. This unguided insertion step is facilitated by the registration of the frame of reference of the parallel kinematic robotic manipulator and the frame of reference of the volumetric imaging system and the use of encoders to accurately and precisely determine the suitable pose of the end effector for alignment of the insertion axis with the trajectory.

[0120] In some example implementations, it can be beneficial to establish a reference location associated with an exposed surface of the anatomical region, or an expected location thereof. For example, knowledge of such a reference location can be beneficial in ensuring that when the parallel kinematic robotic manipulator is actuated to align the insertion axis of the end effector with the trajectory, the portion of the end effector that is not intended for insertion into the anatomical region (e.g. a guide structure for guiding insertion of a medical instrument) does not extend into a region of space that is occupied by the patient anatomy. Accordingly, in some example embodiments, the reference location is employed when calculating the pose of the end effector for alignment of the insertion axis with the trajectory to ensure that the end effector is positioned beyond the expected location of the exposed surface of the patient.

[0121] In some example embodiments, a known reference location associated with an exposed surface of the patient anatomy can be employed to determine the pose of the end effector that is employed for alignment of the insertion axis with the trajectory, such that when the parallel kinematic robotic manipulator is actuated to align the insertion axis of the endeffector with the trajectory, a distal end of the end effector is brought to a location that facilitates mild contact of the end effector with the exposed surface, or such that the end effector resides proximate to, or adjacent to the exposed surface, for example, separated by a small gap of less than 5 mm, 4 mm, 3 mm, 2 mm or 1 mm.

[0122] In some cases, the reference location is mechanically determined by integrating or removably attaching a locating feature to the patient support, and where the patient is positioned such that the surface of the patient (an exposed skin surface) contacts the locating feature. In some implementations of this embodiment, the actual location of the exposed surface may be offset in space relative to the reference location, especially in cases in which the reference location established by a peripheral contact feature, and where the exposed surface protrudes through a central aperture, as the exposed surface can, in some cases, protrude or be withdrawn relative to the peripheral structure.

[0123] In another example implementation, a reference location associated with an exposed surface can be determined by controlled contact with the end effector. For example, the parallel kinematic robotic manipulator can be manually controlled by an operator such that the end effector is brought into contact, or in close proximity, to the exposed surface of the patient, and this pose of the parallel kinematic robotic manipulator can be employed to establish the reference location associated with the exposed surface of the anatomical region. In another example implementation, the docking of the parallel kinematic robotic manipulator with the patient support can be configured such that the docking is rigid in a transverse plane that is perpendicular to a longitudinal direction (e.g. direction in which the craniocaudal axis of the patient is aligned), while permitting relative movement in the longitudinal direction. In such a case, the parallel kinematic robotic manipulator can be brought into a reference pose (e.g. a pose near the center of the workspace, with end effector insertion axis directed to an expected location of the anatomical region), and the parallel kinematic robotic manipulator can be moved, in the longitudinal direction, until the end effector is brought into contact, or in close proximity, to the exposed surface of the patient, thereby establishing a reference location for which the longitudinal position of the parallel kinematic robotic manipulator is locked, via a longitudinal locking feature, to the patient support.

[0124] In yet another example implementation, a non-contact modality, such as an imaging-based modality, can be employed to establish the reference location. For example, a reference location can be determined based on the segmentation of the volumetric image data to define a surface location, or, for example, based on a surface detection device, such as a structured light, laser radar, or stereophotographic camera (e.g. a depth camera) integrated with or supported by the patient support and / or the parallel kinematic robotic manipulator.Example of Patient Support for Performing Pelvic Procedures

[0125] Referring now to FIGS. 3A-3E, an example implementation of a patient support is disclosed that is configured to facilitate access to a pelvic region. The example patient support enables the parallel kinematic robotic manipulator to be positioned under and between the legs of the patient, such that an intermediate region is defined by a gap created when the legs and / or thighs of the patient are articulated to expose the pelvic region.

[0126] Referring first to FIG. 3A, a patient support is shown generally at 40 and consists of leg supports 310 and a support platform 320 that resides on the table or couch 350 of an imaging system 190 (e.g. the gantry of a volumetric imaging system). The patient 5 resides on the patient support 40 with the thighs (and lower legs) articulated outwardly (abducted) to provide access to the pelvic region, and to define the intermediate region in a gap created by the opening of the legs. The parallel kinematic robotic manipulator 10 resides below and between the abducted thighs, at a location that enables the end effector to access the pelvic region, and is secured (e.g. removably secured) to the patient support to facilitate mechanical indexing and spatial registration between the parallel kinematic robotic manipulator and the patient support 40. As shown in FIGS. 3B and 3C, the patient support can optionally include thigh abduction features that facilitate abduction of the thighs, which can be employed, for example, for a subset of patients for which additional support is required or beneficial to provide access to the pelvic region.

[0127] FIGS. 3D and 3E show the inclusion of an example locating feature 370 that is either integrated with or attachable to a remainder of the patient support (e.g. the support platform 320). The patient 5 is placed on the patient support and positioned such that a peripheral portion of the exposed pelvic surface, through which the insertable medical device is intended to pass during the procedure, contacts the locating feature 370, thereby establishing a reference location, in the frame of reference of the patient support, associated with the exposed surface of the patient anatomy, and thus the frame of reference of the parallel kinematic robotic manipulator (via the docking of the parallel kinematic robotic manipulator). As noted above, the reference surface can be employed to determine a suitable pose of the end effector when aligning the insertion axis to the trajectory, for example, such that the end effector avoids entry into the spatial region occupied by the patient anatomy, and / or such that the end effector is brough into contact with the exposed surface, or is positioned adjacent to the exposed surface. The example locating feature 370 includes a housing having a tapered profile that tapers inwardly toward the exposed surface of the patient and contacts the exposed surface in a peripheral zone without occluding a central region of the exposed surface through which the medical instrument will be insertable along a trajectory to which the insertion axis is aligned by the controlled actuation of the parallel kinematic robotic manipulator 10.

[0128] FIGS. 4A and 4B show additional views of an integrated robotic system, including the parallel kinematic robotic manipulator 10, the patient support (showing the leg supports 360 and the support platform 320) and the example locating feature 370, relative to the gantry of the volumetric imaging system 190.

[0129] The example patient support shown in the present example embodiment facilitates the positioning of the patient such that the pelvic region is accessible by the parallel kinematic robotic manipulator. The present embodiment was designed fortransperineal approach for prostate interventions (e.g., biopsy and focal therapy such as cryoablation). However, it will be understood that a wide range of diagnostic and therapeutic procedures can be performed using such a patient support, and variations thereof that facilitate pelvic access, including, for example, surgical procedures, diagnostic procedures, and other treatments and interventions. Non-limiting examples of such procedures include diagnostic imaging and tissue sampling, such as biopsies of pelvic organs (e.g. the prostate) or lymph nodes, therapeutic interventions, such as tumor ablation using radiofrequency, microwave, cryoablation, or laser energy; electrosurgical or ultrasonic dissection for resection of pathological tissue, robotic-assisted laparoscopic procedures for gynecologic or urologic surgery, vascular interventions, including stent placement or embolization, and combined diagnostic-therapeutic procedures, such as targeted drug delivery or brachytherapy seed implantation.

[0130] While many of the example embodiments described herein pertain to the incorporation of a patient support that provides access to a pelvic region for pelvic procedures such as, but not limited to, prostate biopsies and therapeutic interventions involving treatment of pathologies of the prostate, it will be understood that the present disclosure is not intended to be limited to pelvic procedures or procedures involving the prostate, and examples of other types of patient supports that provide access to other anatomical regions are described below. In certain embodiments, patient support may be configured to provide access to other anatomical regions, including but not limited to the abdominal cavity for gastrointestinal or hepatobiliary interventions, the thoracic cavity for cardiothoracic or pulmonary procedures, the cranial region for neurosurgical interventions, and extremities for orthopedic or vascular procedures. Such supports may facilitate robotic-assisted or image-guided interventions, including diagnostic procedures such as tissue biopsies, endoscopic examinations, and intravascular imaging, as well as therapeutic procedures such as tumor ablation, electrosurgical or ultrasonic dissection, vascular stent placement, orthopedic fixation, and targeted drug or radiation delivery.Medical Robotic System Including Parallel Kinematic Robotic Manipulator

[0131] Referring to the embodiment provided in FIGS. 5 and 6A, there is provided an example embodiment of the medical robotic guidance system, configured as the medical roboticsystem 500. The medical robotic system 500 includes the parallel kinematic robotic manipulator 10 configured as the parallel kinematic robotic manipulator 502. The medical robotic system 500 is provided as a compact unit, allowing the medical robotic system 500 to at least partly reside within a confined anatomical region. Said confined region is defined, at least in part, by the anatomy of the patient, such as an intermediate region situated between the articulated thighs of the patient 5 when the patient is supported by the limb support features on the patient support and the patient's thighs are positioned to provide access to a pelvic region. In at least some embodiments, the parallel kinematic robotic manipulator 502 is specifically structured to provide high-precision alignment and insertion capabilities within a spatially constrained working volume. As noted above, the inclusion of such a parallel kinematic robotic manipulator 502 can provide various improvements to both the space efficiency and positional accuracy of the medical robotic system 500 when placing the medical instrument 50 along the insertion axis 55 for insertion into a target region.

[0132] In another aspect, the present disclosure provides for the parallel kinematic robotic manipulator 502 as a standalone system independent of the patient support. In this standalone configuration, the rails 505 may be arranged in a tapered V-configuration to define a compact distal footprint, enabling the parallel kinematic robotic manipulator 502 to fit within confined anatomical spaces when deployed in a medical (e.g. surgical) environment.

[0133] FIGS. 6Ato 6I provide various exemplary embodiments of possible arrangements of the medical robotic system 500, illustrating the positioning of the parallel kinematic robotic manipulator 502 within the medical environment. Further, more detailed example embodiments of the parallel kinematic robotic manipulator 502 and the medical robotic system 500 are provided in FIGS. 14A through 20D.

[0134] In the embodiment provided in FIG. 6A, the parallel kinematic robotic manipulator 502 includes the base 15 configured as the base 504, the rigid structure 20 configured as the rigid structure 510, and the end effector 30 configured as the end effector 512, the end effector512 being integrated with or attachable to the rigid structure 510. The end effector 512 is configured to facilitate insertion of the medical instrument 50 along the insertion axis 55. The parallel kinematic robotic manipulator 502 also includes the kinematic chains 25 configured as a plurality of kinematic chains 513, where each kinematic chain 513 independently connects the base 504 to the rigid structure 510. The motion of the rigid structure 510 is controlled via the plurality of kinematic chains 513. Each kinematic chain 513 comprises at least one link member 514 and a plurality of joints 516. As shown in FIG. 6A, the plurality of joints 516 includes a distal rotational joint 516b that is structured to permit angular movement between the kinematic chain513 and the rigid structure 510. The medical robotic system 500 also includes a drive system comprising a plurality of drive actuators, each drive actuator being operably coupled to a uniquekinematic chain 513 and controllable to actuate an active joint of the unique kinematic chain 513. In the operation of the parallel kinematic robotic manipulator 502, the plurality of drive actuators are individually controllable to adjust a pose of the rigid structure 510 relative to the base 504.

[0135] In an embodiment, the base 504 is structured to be capable of mechanically docking with the patient support 503 in a defined position and orientation. This docking facilitates spatially registering the parallel kinematic robotic manipulator 502 with the patient support 503. The parallel kinematic robotic manipulator 502 and the patient support 503 are cooperatively configured such that when the parallel kinematic robotic manipulator 502 is docked with the patient support 503 and the patient is supported by the patient support 503 such that the anatomical region is accessible, the drive system is operable to direct the insertion axis 55 toward the anatomical region. This specific configuration can help to maintain registration more easily, as the patient support 503 is used to rigidly constrain the patient relative to the parallel kinematic robotic manipulator 502.

[0136] In an additional embodiment, the base 504 is structured to mechanically dock on the patient support 503, where the docking of the base 504 on the patient support 503 effectively provides a "tabletop" design where the parallel kinematic robotic manipulator 502 resides on top of the patient support 503.

[0137] In at least some embodiments, the medical robotic system 500 can be applied for procedures involving the pelvic region. In at least some of said procedures involving the pelvic region, the patient support 503 can be configured to support the patient in various positions. For example, the patient support 503 can be configured to support the patient such that the articulated thighs of the patient are abducted with the legs of the patient spread laterally apart, to thereby provide access to a pelvic region of the patient (e.g., in a semi-lithotomy or a lithotomy-associated position).

[0138] In an embodiment, the parallel kinematic robotic manipulator 502 and the patient support 503 are configured such that when the parallel kinematic robotic manipulator 502 is docked with the patient support 503 (and the patient is supported with the pelvic region accessible), at least a portion of the parallel kinematic robotic manipulator 502 resides within an intermediate region accessible through a gap formed by the abduction of the thighs (see FIG. 5). As noted above, the medical robotic system 500 is able to maintain registration more easily when the parallel kinematic robotic manipulator 502 is mounted on top of the patient support 503, as the patient support. In embodiments where the parallel kinematic robotic manipulator 502 is connected on the patient support and the pelvic region of the patient is to be accessed, said access may be achieved more readily when the medical robotic system 500 is compact and is sized to sit at least partially underneath or between the legs of the patient when the legsare spread laterally apart and the thighs are abducted. In preparing for procedures involving the access of the pelvic region, the parallel kinematic robotic manipulator 502 provides for suitable articulation of the rigid structure and end effector with smaller range of motion requirements for the link members 514 of the kinematic chains 513 compared to other configurations. Other nonparallel kinematic configurations, such as serial robotic manipulators (e.g., X and Y axis robots), may require a range of motion for their members that would be too large for the confined space, potentially taking up too much of the available space on the patient support 503.

[0139] In an embodiment such as shown in FIG. 5, the parallel kinematic robotic manipulator 502 is sized such that a lateral width of the parallel kinematic robotic manipulator 502 is constrained to reside between the abducted thighs of the patient when the patient is supported by limb support features on the patient support 503.

[0140] To facilitate this positioning, the patient support 503 includes limb support features, which may comprise at least one of leg supports and thigh retractors. These features support the patient such that a maximum lateral width of the parallel kinematic robotic manipulator 502 is sized to be less than a minimum lateral distance between the thighs of the patient when the patient resides on the patient support 503 with the thighs supported in the articulated (e.g., abducted) configuration by the limb support features.

[0141] In the specific embodiment shown in FIG. 5, the patient support 503 is an elongate support platform that defines a longitudinal direction, and that is structured to support the patient along said longitudinal direction. The patient support 503 can also define a longitudinal support axis that extends substantially along the longitudinal direction. In at least some embodiments, the parallel kinematic robotic manipulator 502 is structured such that when the base 504 is docked with the patient support 503 at the defined position and orientation, the end effector 512 is held in a position and orientation, connected to the rigid structure 510 such that a projection of the insertion axis 55 onto the longitudinal support axis is larger than a projection of the insertion axis 55 onto a plane perpendicular to the longitudinal support axis. Said another way, the parallel kinematic robotic manipulator 502 is structured such that when the base 504 is docked with the patient support 503 at the defined position and orientation, the end effector 512 is held in a position and orientation such that the insertion axis 55 has at least a primary directional component that is aligned with the longitudinal support axis. This specific alignment of the parallel kinematic robotic manipulator 502 with the longitudinal direction allows the system to take advantage of the free space between the legs. This spatial arrangement enables easy insertion and removal of the robot relative to the patient and provides necessary access for the clinician to perform manual tasks, such as creating skin nicks prior to instrument insertion.

[0142] In an embodiment, the plurality of kinematic chains 513 of the parallel kinematic robotic manipulator 502 are structured such that when the manipulator 502 is docked to the patient support 503 at the defined position and orientation, a reachable orientation workspace volume is defined for the end effector 512. The overall structural length of the parallel kinematic robotic manipulator 502 is largely determined based on the required longitudinal size of this workspace to ensure adequate coverage of the target anatomy. In some operational examples involving accessing an exposed pelvic surface on the pelvic region of a patient, this reachable orientation workspace volume can be partly superimposed over the pelvic region of the patient and is intersected by the insertion axis 55. Generally, the kinematic chains 513 are structured such that the reachable orientation workspace volume has a longitudinal dimension that is substantially parallel to a longitudinal axis of the patient support 503. In specific embodiments, this longitudinal dimension of the reachable orientation workspace volume is greater than a transverse dimension of the workspace volume, where the transverse dimension is perpendicular to the longitudinal direction. Accordingly, the plurality of kinematic chains 513 are structured such that the reachable orientation workspace volume has a generally cylindrical shape. In one non-limiting example, the workspace may define a 70 mm diameter transverse dimension with a longitudinal depth of approximately 2.5 cm or greater depending on the target depth.

[0143] In the various embodiments of the present disclosure, plurality of kinematic chains513 of the parallel kinematic robotic manipulator 502 are structured to be capable of aligning the medical instrument 50 in at least four degrees of freedom, such as translation in X and Y axes and rotation in pitch and roll. In various additional embodiments, the parallel kinematic robotic manipulator 502 is configured to be capable of aligning the medical instrument 50 in five or six degrees of freedom. These degrees of freedom can include, for example, linear translation in X, Y, and Z (insertion / retraction) axes, and rotations in X (roll), Y (pitch), and Z (yaw) axes.

[0144] Regarding the positioning of the system relative to the patient, the design ensures that the parallel kinematic robotic manipulator 502 does not touch the patient during movement, while facilitating positioning of the end effector 512 as close to the perineum as possible. It is desirable to minimize the gap to the perineum without the medical instrument 50 or end effector 512 scratching against the perineum during alignment adjustments. To achieve this, the parallel kinematic robotic manipulator 502 is provided with extra freedom to move back (proximally) away from the perineum. In use, the patient is positioned at a known datum along the Z-axis (longitudinal axis) of the patient support 503. The parallel kinematic robotic manipulator 502 is configured to move back a certain amount along the Z-axis, providing a range of global movement with significant actual travel. This configuration facilitates a workflow involving grossmotion without the robot (e.g., moving the patient support 503) and fine motion with the robot (e.g., actuating the parallel kinematic robotic manipulator 502).

[0145] In some operational examples involving accessing an exposed pelvic surface on the pelvic region of a patient, the medical (e.g. surgical) robotic system 500 is configured such that a volumetric center point of a reachable orientation workspace of the parallel kinematic robotic manipulator 502 corresponds substantially to a center point of the perineum on the exposed pelvic surface. To further optimize the workspace usage and accommodate patients of various Body Mass Indexes (BMIs), some embodiments of the patient support 503 are provided with a vertical lifting capability (e.g., height adjustment). This adjustment capability allows the operator to align the patient's anatomy vertically with the robot's optimal workspace, thereby reducing the required vertical range of motion for the parallel kinematic robotic manipulator 502 itself.

[0146] Regarding the positioning of the medical instrument relative to the patient, the parallel kinematic robotic manipulator 502 is structured to facilitate the positioning of the end effector 512 in close proximity to the perineum. However, it is generally beneficial to provide a safety gap between a distal end of the medical instrument 50 (or end effector 512) and the tissue surface of the patient (e.g., the perineal surface) during navigation. While minimizing the gap is desirable for instrument reach, sufficient clearance must be preserved to prevent inadvertent contact or scratching of the distal tip against the patient's skin during lateral alignment adjustments. To achieve this balance, the parallel kinematic robotic manipulator 502 is, in at least some embodiments, provided with additional kinematic freedom to retract proximally away from the perineum, thereby creating a safe buffer zone for re-orientation.

[0147] In an example method of setting up the medical robotic system 500 to provide this safe buffer zone, the patient is initially positioned at a known datum along the longitudinal direction of the patient support 503. Subsequently, the parallel kinematic robotic manipulator 502 is configured to move or be positioned proximally a predetermined distance along the longitudinal direction relative to the patient. This positioning provides a range of global movement with significant actual travel available for the insertion stroke. This configuration facilitates a hierarchical positioning workflow involving a "gross motion" adjustment of the entire structure of the parallel kinematic robotic manipulator 502 relative to the patient support 503 to establish the workspace, followed by "fine motion" actuation of the parallel kinematic robotic manipulator 502 (via the drive system 518) to perform the precise instrument alignment and insertion.

[0148] Various arrangements of the patient support 503 and base 504 can provide the mechanical interface that facilitates the docking between these two components. In an embodiment, the base 504 and the patient support 503 are cooperatively configured to provide mechanical docking therebetween.

[0149] In an additional embodiment, the base 504 and the patient support 503 each include at least one corresponding connecting feature. These corresponding connecting features on the base 504 and patient support 503 are structured to releasably connect together so as to rigidly establish the defined position and orientation between the base 504 and the patient support 503. In at least some other embodiments, distinct connecting features may be provided primarily on only one of the base 504 and the patient support 503. For example, the base 504 may include an active locking mechanism (e.g., a clamp or latch) configured to engage a passive structural feature (e.g., a frame rail, edge, or surface) of the patient support 503, or vice versa. Regardless of the specific distribution of components, the interface is structured to rigidly establish the defined position and orientation between the base 504 and the patient support 503. In various embodiments, the corresponding structural features on the base 504 and patient support 503 are selected from the group comprising: a pin and socket mechanism, a rail and channel mechanism, a rigid alignment plate, and a quick-release latch.

[0150] To further facilitate accurate procedure execution, the patient support 503 may include embedded registration fiducials that enable spatial registration of the patient support 503 within an imaging volume, thereby enabling the docking of the parallel kinematic robotic manipulator 502 to establish a known coordinate link between the robot and the image data.

[0151] In an embodiment such as shown in FIG. 5, the parallel kinematic robotic manipulator 502 further comprises a housing 590 that at least partially surrounds the plurality of kinematic chains 513. To ensure the system remains compatible with the anatomical constraints of the procedure, at least a portion of the housing 590 is laterally tapered. This tapered profile is specifically shaped so as to avoid contact with the thighs of the patient when the base 504 is mechanically docked with the patient support 503 and the patient resides on the patient support 503 with the thighs supported in the abducted configuration.

[0152] The medical robotic system can include various configurations of the parallel kinematic robotic manipulator 502. Previously provided embodiments describe general embodiments of parallel kinematic robotic manipulator 502 and the functionality thereof. Referring to FIGS. 6B to 6I, there are provided number of example embodiments of the parallel kinematic robotic manipulator 502.

[0153] In at least some embodiments, the parallel kinematic robotic manipulator 502 is configured as a prismatically driven parallel kinematic robotic manipulator. In the prismatically driven configuration of the parallel kinematic robotic manipulator 502, each kinematic chain 513 includes at least one prismatic joint that is actively driven by a respective drive actuator of the plurality of drive actuators, and all the rotational joints within each kinematic chain 513 are passive joints, such as spherical joints or universal joints, that facilitate orientation flexibility without requiring direct actuation at the joint itself.

[0154] In the example embodiment provided in FIG. 6E, the prismatically driven parallel kinematic robotic manipulator is configured as a Gough-Stewart prismatically driven parallel kinematic robotic manipulator 502a. In the specific embodiment of the Gough-Stewart prismatically driven parallel kinematic robotic manipulator 502a shown in FIG. 6E, the plurality of kinematic chains 513 include six kinematic chains of six linear actuators 514a (e.g., prismatic joints) that form the link members 514 and that are connect via pivoting hinge joints 521 to a fixed base ring 523 (which as an example configuration of the base 504), while also being connected via joints to the rigid structure 510, which is arranged as a mobile platform 510a. By varying the lengths of the linear actuators (by the actuation thereof), the rigid structure 510 can be positioned and oriented with six degrees of freedom relative to the fixed base 523.

[0155] In at least some embodiments, the parallel kinematic robotic manipulator 502 is configured as a slider-based prismatically driven parallel kinematic robotic manipulator, where the prismatic actuation of the medical instrument 50 connected to the parallel kinematic robotic manipulator 502 is achieved, at least in part, by slidably translating one end of at least some of the link members 514 relative to the base 504, where the slidable translating of one end of said link members 514 will drive a change in position and orientation of the link member 514, and an associated change in the position and orientation of the rigid structure 510 to which the link member 514 is connected (via the pivot joint). The distribution of the link members 514 across the rail system defines, in part, the kinematics of the slider-based prismatically driven parallel kinematic robotic manipulator.Rails

[0156] In at least some embodiment where the parallel kinematic robotic manipulator 502 is the slider-based prismatically driven parallel kinematic robotic manipulator, the base 504 includes a rail system comprising at least two spaced apart elongate rails 505, the rail system including a proximal rail region and a distal rail region. As shown, for example, in FIGS. 6B and 6C, the configuration of the rail system on the base 504 is such that each of the at least two elongate rails 505 includes a proximal end located in the proximal rail region and a distal end opposite the proximal end located in the distal rail region. In an additional embodiment such as shown in FIGS. 6B and 6C, the parallel kinematic robotic manipulator 502 and the patient support 503 are configured such that when the parallel kinematic robotic manipulator 502 is docked with the patient support 503, the rail system resides, at least in part, between the thighs of the patient and extends along the longitudinal direction with the distal rail region being disposed closer to the pelvic region than the proximal rail region.

[0157] In some embodiments such as shown in FIGS. 6B, 6C, and 6D, the rails 505 are oriented such that they extend along the longitudinal direction of the patient support 503 and are substantially parallel to one another and to said longitudinal direction.

[0158] In other embodiments such as provided in FIG. 6F, the parallel kinematic robotic manipulator 502 can have a tapered footprint and the at least two elongate rails 505 are oriented such that a longitudinal axis of each elongate rail 505 bisects an axis that is parallel to the longitudinal direction, creating a symmetric convergence toward the distal end.Stability

[0159] At least some embodiments of the parallel kinematic robotic manipulator 502 that include the rail system may be inherently structured such that, if the kinematic chains 513 extend too far laterally outward over the rails 505, the parallel kinematic robotic manipulator 502 may lose mechanical stability or approach one or more kinematic singularities. To address this, the parallel kinematic robotic manipulator 502 is configured to limit the lateral excursion of the link members. This limitation may be enforced via software control and / or physical constraints. In an example embodiment, the parallel kinematic robotic manipulator 502 is configured such that, throughout a full range of motion of the end effector 512 within the reachable orientation workspace volume, no portion of the plurality of kinematic chains 513 extends laterally beyond two vertical planes defined by laterally outermost edges of at least two elongate rails 505 of the base 504.Length Changing Members

[0160] In an additional embodiment of the slider-based prismatically driven parallel kinematic robotic manipulator, the link members 514 of at least some of the kinematic chains513 are configured as linear actuators.

[0161] In the specific embodiment provided in FIGS. 6B and 6C, the rail system includes two spaced apart, elongate rails 505, with a single slider 538 movably mounted on a first one of the elongate rails 505, and two distinct sliders 538 movably mounted on a second one of the elongate rails 505. In this embodiment, the kinematic chains 513 each include link members514 formed as linear actuators 514a connected between the rigid structure 510 and the sliders 538. The linear actuators 514a serve as active prismatic links capable of extending and retracting to control the pose of the rigid structure 510. The linear actuators 514a are connected to the rigid structure 510 via spherical joints 516, and the linear actuators 514a are connected to the sliders 538 via pivot hinge joints configured to provide three degrees of freedom, thereby allowing the linear actuators 514a to pivot and rotate relative to the rails 505 as the sliders 538 translate and the linear actuators 514a change length.Fixed Members

[0162] In an alternate embodiment of the slider-based prismatically driven parallel kinematic robotic manipulator, the link members 514 of all of the kinematic chains 513 are configured to have a fixed length.

[0163] To provide the slidable translation of the ends of the link members 514 relative to the at least two elongate rails, the plurality of kinematic chains 513 include a plurality of carriage assemblies 540 that are configured to translate along the at least two elongate rails 505.Various configurations of the plurality of carriages are shown in the embodiments of FIGS. 6D to 6I. Generally, the plurality of carriage assemblies 540 are distributed between the at least two elongate rails 505 such that each carriage assembly 540 is movably connected to only one elongate rail 505. Each link member 514 is operably connected (via the pivot joints) between one of the carriage assemblies and the rigid structure 510 for converting the sliding translations of the carriage assemblies along the at least two elongate rails 505 into the complex spatial motion of the rigid structure 510 and end effector 512.

[0164] In at least some embodiments, a unique carriage assembly 540 is included within each kinematic chain 513, and the link member 514 of each kinematic chain 513 is operably connected between the rigid structure 510 and the unique carriage assembly 540 via the plurality of joints, with at least one joint being connected at either end of the link member 514.

[0165] Five different example embodiments of the slider-based prismatically driven parallel kinematic robotic manipulator with fixed-length members are illustrated in FIGS. 6D to 6I. In each of these example embodiments, prismatic actuation of the medical instrument 50 connected to end effector 512 on the rigid structure 510 of the parallel kinematic robotic manipulator 502 is achieved not by changing the length of the struts themselves, but by sliding the carriage assemblies relative to the base 504, along the at least two elongate rails 505.

[0166] In an embodiment such as shown in FIG. 6D, the parallel kinematic robotic manipulator 502 is structured to include at least four kinematic chains 513. In embodiments utilizing the at least four kinematic chains 513, the link members 514 of the plurality of kinematic chains 513 include at least first, second, third, and fourth link members 514c, 514d, 514e, 514f. From a manufacturing and cost-optimization perspective, it is advantageous in some embodiments for the link members 514 to have substantially similar lengths.

[0167] In the specific embodiment provided in FIG. 6D, the parallel kinematic robotic manipulator 502 (shown as parallel kinematic robotic manipulator 502b in FIG. 6D) includes only four kinematic chains 513 with four carriage assemblies 540, the rigid structure 510, and the first, second, third and fourth rigid members 514c, 514d, 514e, 514f each connected between a unique carriage assembly 540 and the rigid structure 510 via the pivot joints 516.

[0168] In an additional embodiment where the parallel kinematic robotic manipulator 502 is structured to include at least four kinematic chains 513 comprising the at least four link members, the first and second link members 514c, 514d are pivotably connected to the rigid structure 510 (via pivot joints 516) at first and second connection locations 518a, 518b remote from the proximal end (e.g., at the distal end) of the rigid structure 510. Conversely, the third and fourth link members 514e, 514f are pivotably connected to the rigid structure 510 (via pivot joints 516) at third and fourth connection locations 518c, 518d remote from the distal end (i.e., at the proximal end) of the rigid structure 510. The connection of the link members 514 to the rigid structure via the pivot joints 516 is shown, for example, in FIG. 6D.

[0169] In embodiments where the base 504 includes two spaced apart elongate rails 505 extending along the longitudinal direction, the connection locations of the link members 514 on the rigid structure 520 are distributed to balance forces.

[0170] In the various embodiments of the rigid structure 510 and the connection locations for the link members 514, the separation distance between connection locations can be varied. For example, a separation distance between the first and second connection locations can be configured to be less than a separation distance between the third and fourth connection locations to facilitate more precise control at a distal tip of the medical instrument 50 that is supported by the end effector 512, while the wider spacing at the proximal end provides structural stability.

[0171] In the specific embodiment provided in FIG. 6F, the parallel kinematic robotic manipulator 502 (shown as parallel kinematic robotic manipulator 502c in FIG. 6F) includes six kinematic chains 513 with six carriage assemblies 540. The six kinematic chains 513 includes the first, second, third and fourth rigid members 514c, 514d, 514e, 514f, as well as fifth and sixth elongate members 514g, 514h that are each connected between a unique carriage assembly 540 and the rigid structure 510 via the pivot joints 516.

[0172] As shown in FIG. 6F, the fifth and sixth members are pivotably connected to the rigid structure 510 at fifth and sixth connection locations remote from the distal end. Consistent with the tapered geometry, the separation distance between the first and second connection locations is less than a separation distance between the fifth and sixth connection locations.

[0173] In at least some embodiments, the connection locations on the rigid structure 510 are arranged to be asymmetric about one or more dimensions of the rigid structure 510.

[0174] In an embodiment such as shown in FIG. 6G, the structure of the parallel kinematic robotic manipulator 502 defines a central bisecting plane (B) that is perpendicular to a plane containing the two elongate rails 505. In a symmetric design, connections would be mirrored. However, in these embodiments, the third and fifth members and the fourth and sixth members are asymmetrically arranged on either side of the central bisecting plane. As shown in FIG. 6G,this asymmetric arrangement can be achieved by arranging the third and fifth connection locations on the rigid structure 510 to be asymmetric to the fourth and sixth connection locations about the central bisecting plane. This non-symmetric connection layout on the rigid structure 510 is specifically designed to address yaw moments (e.g., rotations about a vertical axis that is orthogonal to a longitudinal axis defined along the longitudinal direction. The asymmetry provides a better rate of change of velocity and increases stiffness against yaw forces, which is particularly beneficial when the medical instrument 50 is subjected to lateral forces during instrument insertion. FIG. 6H provides an alternative, asymmetric arrangement of the third, fourth, fifth and sixth connection locations on the rigid structure 510.

[0175] In some embodiments of the slider-based prismatically driven parallel kinematic robotic manipulator, the rail system of the base 504 includes only two spaced apart elongate rails 505 which extend generally along the longitudinal direction of the patient support 503. This two-rail configuration is illustrated, for example, in FIGS. 6B and 6C, as well as in the embodiments of FIGS. 6D and 6E.

[0176] In limiting the parallel kinematic robotic manipulator 502 to include only two elongate rails 505, multiple kinematic chains 513 will use the same rail 505. By having multiple kinematic chains 513 utilize the same rail 505, the parallel kinematic robotic manipulator 502 remains compact (e.g., an overall footprint of the parallel kinematic robotic manipulator 502 is reduced) while maintaining precise control. The cooperative movement of carriages on the two elongate rails 505 facilitates control of the rigid structure 510 in multiple degrees of freedom.

[0177] Referring to FIG. 6D, there is provided a first embodiment of the slider-based, prismatically driven, parallel kinematic robotic manipulator 502b with link members 514 of fixed length(s). The parallel kinematic robotic 502b includes the rigid structure 510 and the end effector 512. The plurality of kinematic chains 513 independently connect the rail system of the base 504 to the rigid structure 510, and a unique carriage assembly is provided for each kinematic chain 513. In the specific embodiment provided in FIG. 6D, the rigid structure 510 is a rectangular platform 510b, with the end effector 512 fixedly connected to the distal end of the rectangular platform 510b. The two spaced apart elongate rails 505 are two parallel, rod-shaped rails 505b that are disposed on opposing lateral sides of the rectangular platform 510b.

[0178] In some embodiments, such as those shown in FIGS. 6B, 6D and 6H, the two rails 505 are substantially parallel to one another and aligned along the long direction of the patient support 503.

[0179] In other embodiments, such as shown in FIG. 6F, the rails 505 are positioned at angles relative to one another. In at least some of these embodiments, the structure of the parallel kinematic robotic manipulator 502 can be said to define a central bisecting plane that is perpendicular to a plane containing the two elongate rails 505. Geometrically, a first of the twoelongate rails 505 is positioned at a first angle relative to the central bisecting plane, and a second of the two elongate rails 505 is positioned at a second angle relative to the central bisecting plane. In various embodiments, the first and second angles may be substantially equal or different.

[0180] In the embodiment illustrated in FIG. 6F, there is provided a second embodiment of the slider-based, prismatically driven, parallel kinematic robotic manipulator 502c with link members 514 of fixed length(s). In the specific embodiment provided in FIG. 6F, the rigid structure 510 is a tapered platform 510c, with the end effector 512 fixedly connected to the distal end of the tapered platform 510c. The two elongate rails 505 are positioned at a non-zero angle relative to each other such that a lateral space between the distal ends of the two elongate rails 505 is smaller than a lateral space between the proximal ends of the two elongate rails 505. The two elongate rails 505 are symmetrically arranged and mirrored about the central bisecting plane to thereby define a V-rail pair.

[0181] There are multiple benefits to the functioning of the parallel kinematic robotic manipulator 502c that are provided by utilizing such a V-rail arrangement. First, the tapered angulation of the elongate rails 505 accommodates the specific force profiles generated during X and Y motion, allowing for an optimization of stability and speed of the rigid structure 510 as the position and orientation of the rigid structure 510 is varied due to the movement of the carriage assemblies along the two rails 505. A wider spacing of the proximal ends of the two elongate rails 505 provides increased mechanical stability for the rigid structure 510, while narrower spacing of the distal ends of the two elongate rails 505 allows for higher speed movements and better dynamic response. This configuration offers the "best of both worlds" regarding kinematic performance. Furthermore, the angulation of the V-shape for the two elongate rails 505 is designed to accommodate patient anatomy. On a system with a patient support 503 accessing the pelvic region, space constraints enforce a need to have a narrower distal end. The patient's legs consume much of the volume where the robot could be situated on the patient support, especially close to the perineum. The V-rail configuration allows the parallel kinematic robotic manipulator 502c to fit into this constrained volume while maintaining the wider base to provide improved stability further towards the proximate region of the rail system.

[0182] Referring again to the specific embodiment provided in FIG. 6F where the base 504 includes the two elongate rails 505 that form the V-rail pair, the plurality of kinematic chains 513 comprises six kinematic chains 513, such that the plurality of carriage assemblies 540 includes six unique carriage assemblies 540. In this six-chain configuration, the carriages are distributed such that a first set of three carriage assemblies 540 is movably coupled to the first elongate rail 505, and a second set of three different carriage assemblies 540 is movably coupled to thesecond elongate rail 505. A unique drive actuator of the plurality of drive actuators is provided on each carriage assembly 540 for independently driving the carriage assembly 540 along the associated elongate rail 505.

[0183] For example, as shown in FIG. 6D, the kinematic chains 513 include first to fourth members, that include the third and fifth members are operably connected to a first of the two elongate rails 505, while the kinematic chains 513 that include the fourth and sixth members are operably connected to a second of the two elongate rails 505. Similarly, as shown in FIG. 6F, the kinematic chains 513 that include the third and fifth members are operably connected to a first of the two elongate rails 505, while the kinematic chains 513 that include the fourth and sixth members are operably connected to a second of the two elongate rails 505.

[0184] In an embodiment, the at least two elongate rails 505 include more than two elongate rails 505. For example, FIG. 6G provides a third embodiment of the slider-based prismatically driven parallel kinematic robotic manipulator 502d where the rail system has a four-rail configuration of four elongate rails, FIG. 6H provides a fourth embodiment of the sliderbased prismatically driven parallel kinematic robotic manipulator 502e where the rail system has a three-rail configuration of three elongate rails, and FIG. 6I provides a fifth embodiment of the slider-based prismatically driven parallel kinematic robotic manipulator 502f where the rail system has a six-rail configuration of six parallel rails.

[0185] In an additional embodiment such as shown in FIG. 6G where the slider-based prismatically driven parallel kinematic robotic manipulator 502d has the four-rail configuration with the four elongate rails 505, the structure of the parallel kinematic robotic manipulator 502 defines the central bisecting plane (B) that is perpendicular to a plane containing the four elongate rails 505. The four elongate rails 505 are symmetrically arranged and mirrored in pairs about the central bisecting plane to thereby define a proximal V-rail pair 505b and a distal V-rail pair 505a. In certain multi-rail configurations, proximal V-rail pair 505b and distal V-rail pair 505a of the elongate rails 505 are relatively arranged to provide specific geometry. For example, a largest separation distance between the rails of the distal V-rail pair, in a direction orthogonal to the central bisecting plane, may be greater than a largest separation distance between the rails of the proximal V-rail pair in said direction. Similarly, a smallest separation distance between the rails of the distal V-rail pair may be greater than a smallest separation distance between the rails of the proximal V-rail pair. Similar to the two-rail V-configuration, these multi-rail arrangements utilize tapering and angulation to optimize force profiles for X and Y motion and to balance stability with the anatomical constraints of the pelvic region.

[0186] In an embodiment such provided in FIGS. 6F, and 6G, the rigid structure 510 (also referred to as the mobile platform) is specifically adapted for the medical (e.g. surgical) environment. In various embodiments, the rigid structure 510 has an elongate form defined by aproximal end and a distal end. When deployed, the distal end is disposed closer to the distal rail region of the rail system than the proximal end, positioning it nearer to the target pelvic region. To accommodate the anatomical constraints of the patient (e.g., the space between abducted thighs), the rigid structure 510 preferably has a tapering form such that a width of the proximal end is greater than a width of the distal end. This taper of the rigid structure 510 can, in some embodiments, mirror the tapering of the at least two elongate rails 505 described previously, maximizing the available workspace while further preventing collision with the patient's legs.

[0187] As described above, the end effector 512 is generally integrated with or attachable to the rigid structure 510 such that the end effector 512 resides remote from the proximal end of the rigid structure 510, projecting distally towards the patient. The end effector 512 can take various forms depending on the specific surgical requirement. In one embodiment, the end effector 512 comprises a guide structure defining a guide axis, where the guide axis is collinear with the insertion axis 55 to guide the medical instrument 50. In another embodiment, the end effector 512 comprises the medical instrument 50 itself, where the medical instrument 50 has a distal elongate portion configured to be inserted along the insertion axis 55. In yet another embodiment, the end effector 512 comprises a support structure configured to releasably hold the medical instrument 50 such that a distal elongate portion of the medical instrument 50 is aligned with the insertion axis 55 for insertion.

[0188] As provided above, the drive actuators of the drive system facilitates the precise movement of the kinematic chains 513 along the rails 505. In some embodiments of the drive system , the plurality of drive actuators are integrated directly as part of the plurality of carriage assemblies 540.

[0189] In an additional embodiment, each drive actuator comprises a rotary actuator configured to generate rotary motion. This rotary motion is mechanically transferred to drive linear motion of the carriage assembly 540 along the respective elongate rail 505. In one exemplary embodiment, the motion transfer from the rotary actuator 542 to the linear motion along the rails 505 is achieved through a rack and pinion mechanism. In this arrangement, a gear rack is provided along the length of the elongate rail 505, and a pinion gear driven by the rotary actuator engages the rack to propel the carriage assembly 540.

[0190] The present disclosure contemplates various other drive mechanisms for driving the slidable translation of the carriage assemblies 540 along the rails 505. For example, in other embodiments, the carriages 540 can be cable driven or belt driven, utilizing a pulley system to transfer the rotary output to linear displacement. In further embodiments, the carriages 540 can be leadscrew driven, utilizing a threaded interface to convert rotation into precise linear translation. In yet other embodiments, the carriages 540 are friction driven. This configurationmay involve, for example, utilizing high-friction rubber wheels driven by the rotary actuator 542 to directly engage a surface of the rail 505 to generate the necessary traction for movement.

[0191] In an embodiment, the parallel kinematic robotic manipulator 502 is constructed substantially from MRI-compatible materials such that the medical robotic system 500 can operate within the high-magnetic field environment of an MRI imaging system. In this embodiment, the base 504, the plurality of kinematic chains 513, the rigid structure 510, and the end effector 512 are fabricated from non-ferromagnetic materials to prevent magnetic attraction forces and to minimize image artifacts (e.g., susceptibility artifacts) in the resulting volumetric image data. Components of the parallel kinematic robotic manipulator 502 requiring high stiffness, such as the elongate rails 505 and the link members 514, can be constructed from materials such as high-strength engineering plastics (e.g., PEEK, or Acetal), ceramic composites, or non-ferrous metals such as aluminum, titanium, or brass. Beyond the structural components of the parallel kinematic robotic manipulator 502, the electromechanical subsystems of the parallel kinematic robotic manipulator 502 can also be selected for MRI compatibility. In embodiments, the drive system is configured to not include traditional electromagnetic motors, and instead comprises piezoelectric motors.

[0192] To provide for further MRI compatibility, the medical robotic system 500 can be configured utilizes an electrical encoder-based positioning system that is independent of external optical tracking. In the confined space of an MRI bore, patient anatomy and the limited volume often obstruct the line of sight required for camera-based tracking systems, rendering them unreliable for real-time control. Instead, the system is configured to measure the position of the joints directly with electrical encoders and calculate the position of the end effector 512 (and the needle tip) utilizing a kinematic model (e.g., a Jacobian matrix). To ensure MRI compatibility, the components of this positioning system are constructed from non-magnetic materials and utilize signaling methods, such as optical encoding, that are immune to magnetic interference.

[0193] The drive system comprises a plurality of piezoelectric motors, which are selected for their non-magnetic properties and high precision. A transmission train, such as a gear train, is coupled to each motor. To provide closed-loop motion control, specifically regarding velocity and motor commutation, a primary encoder is coupled to the shaft of each motor. This primary encoder may be an incremental quadrature encoder. To determine the precise spatial positioning of the kinematic chain 513 immediately upon power-up or after a power cycle, an absolute position encoder is coupled to the output of the transmission train (the load side). This arrangement ensures that the true position of the carriage assembly 540 is known regardless of the state of the motor shaft.Example System Implementation for Magnetic Resonance Guided Medical Procedures

[0194] A schematic representation of a robot system overview is shown in FIG. 7. The system includes a robot manipulator 1010, a robot controller 1012 and a robot workstation 1014. A patient 1016 is placed on a patient support 1018. The patient support may be placed on a table, a surgical bed or an MRI table. The patient support 1018 may be pushed into and out of an imaging system such as a MRI scanner 1020. The imaging system 1020 is operably connected to an imaging console 1022. A technician and / or physician 1024 controls the robot workstation 1014 and / or the imaging console 1022.

[0195] The patient support 1018 typically has embedded registration fiducials. The patient support 18 enables the docking of the robotic manipulator 1010. The robotic manipulator 10 is designed to align and position a medical instrument (not shown), such as a biopsy gun or ablation needle, to reach the target location. The robot controller 1012 receives target information from the robot workstation 1014 based on the target, calculates robot trajectory and powers the robot manipulator 1010. The robot workstation 14 also receives images from an imaging systems such as an MRI scanner 1020, a physician then identifies the target tissues and sends the target location to the robot controller 1012. A bedside controller 1015 may be used to control the robot manipulator.

[0196] A more detailed schematic representation of an overview of robot system shown in FIG. 7 is shown in FIGS. 8, 9 and 10. Typically, a robot system for use in an MRI has positioned in a console room 1100 (shown in FIG. 8), a instrumentation room 1102 (FIG. 9) and a scanner room 1104 (FIG. 10). Typically, the robot workstation 1014 and the MRI console 1022 are housed in the console room 1100. The robot controller 1012 may be in the instrumentation room 1102, the console room 1100 or the scanner room 1104. The robot manipulator 1010, patient support 1018, MRI scanner 1020 and the bedside controller 1015 are typically in the scanner room 1104.

[0197] The robot workstation 1014 is composed of a user interface screen 1110 and a computer 1112. The robot workstation 1014 includes user software. There are at least two options to access the user software, namely a web cloud-based software application accessible using a computer with a web browser; and a software application installed on an on-site computer.

[0198] Using the robot workstation, the user retrieves the images from the MRI scanner, registers the robot manipulator and identifies the target(s). The robot workstation determines the trajectory and depth of insertion to reach the target location. The robot workstation passes the trajectory and depth of insertion to the robot controller as well as the bedside controller which is operably connected to the robot controller 1012. The robot workstation allows a user to move the robot to the target pose for aligning the insertion of an interventional instrument alongthe trajectory via the needle guide. It also allows user to manually move the robot freely (i.e., without a target trajectory).

[0199] The robot controller 1012 consists of an AC / DC Power Supply (or supplies) 1114 to convert AC power 1116 to DC power required to power the robot manipulator 1010 and robot controller 1012. The robot controller 1012 may also contain battery back-up 1115 to power the system in case of AC power loss. One of the benefits of battery back-up is to be able to drive the robot to remove it from the patient support and have uninterrupted access to the patient in case of a power loss.

[0200] The robot controller 1012 consists of a real-time computer 1118 running robot software that receives the target trajectory and depth of insertion from robot workstation’s user software and manual motion commands from robot workstation’s user software and bedside controller 1015. The robot controller’s robot software calculates the desired movement for each carriage and commands the motion through the motor drivers 1120.

[0201] The robot controller 1012 may be placed in the instrumentation room 1102 or the console room 1100. In an example embodiment, the robot controller may be designed to be placed in the scanner room 1104.

[0202] Bedside controller 1015 is used to control the robot manipulator 1010 within the scanner room 1104. A touchscreen or a tablet may be utilized for the bedside controller 15. In one example, the bedside controller 1015 shows the target trajectory and depth of insertion. The bedside controller allows a user to move the robot to the calculated pose to position the needle guide for insertion of a guided interventional instrument along the target trajectory. It also allows user to manually move the robot freely (i.e., without a target trajectory).

[0203] In some example implementations, once the robotic manipulator has been moved to align the needle guide such that a distal end of the needle guide contacts the external anatomy of the subject at a known location (e.g. based on known anatomical surfaces determined from the volumetric image data, or segmentation thereof, or based on controlled actuation by the user to drive the robotic manipulator into contact with the subject), the user can employ one or more known reference markings and / or structural stops to insert the insertable instrument to a prescribed depth. For example, the insertable interventional instrument may have markings along an axis thereof that can be employed to determine a suitable depth relative to a reference location on the needle guide assembly. Alternatively, one or more structural stops may be secured to the interventional instrument to prevent insertion beyond a prescribed depth via engagement with a corresponding surface or protrusion on the needle guide assembly.Example Workflows for Image Guided Medical Procedures

[0204] One example and non-limiting workflow is illustrated in in the flow diagram shown in FIGS. 11 A and 11 B. The example flow diagram can be divided into a number of general sections including patient / robot setup; image acquisition and retrieval; image registration; selecting target and trajectory; determination of target carriage positions; moving the robot manipulator to achieve target trajectory; insertion of medical instrument; determination of absolute positioning of the carriages; and manually moving the robot manipulator.

[0205] At the start of the procedure, the patient and robot set-up begins with the patient support device is placed on the MRI table by the user.

[0206] The patient is then placed on the patient support device. For a transperineal approach of the prostate (for example for a biopsy or focal therapy procedure), the patient will be placed supine with their legs raised and supported by the patient support device such that there is optimal access to the patient’s perineum. The patient support device may include mechanical articulations to allow supporting hips and the knees, ankles and other parts of the legs to accommodate large patient demographics.

[0207] Next, the robot manipulator is attached on a fixed location on the patient support. There may be a few different fixed locations on the patient support on to which the robot manipulator can be fixed to allow an optimal positioning of the robot manipulator to access patient’s perineum based on the patient. The exact location on to which the robot manipulator is attached can be detected by a switch on the robot manipulator or the patient support device that sends a signal to the robot controller.

[0208] Next, the robot is moved to an optimal starting position relative to the patient’s perineum using the bedside controller. The bedside controller can also be used to move the robot manually as and when needed.

[0209] Once the patient and robot is set up one is ready for image acquisition and retrieval. The MRI table is then pushed inside the MRI bore and MRI images are acquired using the MRI console. Using the robot workstation’s user software on the robot workstation, the user first retrieves the MRI images. New images may be acquired by the user throughout the procedure.

[0210] The user then registers the images. This correlates the image sets to the robotic physical space.

[0211] Once the images have been acquired and retrieved and the user images registered, the user is ready to select the targets and trajectory. The user then identifies the target lesion and identifies the target location on the MRI images. As an example, the target location may be the biopsy location for a biopsy procedure using a biopsy needle. Alternatively, the target may be the location where the user intends to place a cryoablation needle for a cryoablation procedure. The user may select one or more targets. Trajectory planning is performed for each target.

[0212] The robot workstation’s user software is configured with a list of compatible procedures and medical instruments such as biopsy needles, cryoablation needles, laser ablation needles, microwave ablation needles, irreversible electroporation needles, etc. and their specification such as the length, size, etc.

[0213] Based on the procedure and selected medical instrument, the robot workstation’s user software then calculates the trajectory and depth of insertion to reach the desired target. The user reviews the possible trajectories and selects the desired trajectory. The user may adjust the target based on the trajectories which repeat these steps. In case of multiple targets, the user is able to plan the trajectories and depth of insertion for each target and the robot workstation’s user software can store the trajectories and depths of insertion for each target. Alternatively, the user is also able to plan the trajectories and depth of insertion for each target sequentially. The trajectory and depth is also shown in the bedside controller which helps the user to align the robot and insert the medical instrument.

[0214] Once the final trajectory is selected by the user, the robot workstation’s user software passes the desired trajectory and depth of insertion to the robot software running on the real-time computer in the robot controller. The robot controller’s robot software calculates the target pose of the rigid structure, such as the pose of an end-effector (EE) supported or integrated with the rigid structure (position and angle). Using forward kinematic model and the absolute positions of the carriages, the current EE pose can be determined. Using the inverse kinematic model of the robot, the current EE pose and the target EE pose, the target carriage positions can be determined. The target pose may include contact of the distal end of the needle guide with an external anatomical surface of the patient in order to provide a physical reference for depth determination.

[0215] Next, the user commands motion of the robot to the target trajectory using the bedside controller or robot workstation’s user software. This may be a continuous action (e.g., continuously pressing an icon) until the robot aligns to the trajectory or a single action (e.g., pressing an icon once) enabling the robot to move to the target. While the system can automatically move the robot, the user-in-the-loop is a safety feature that allows user to prevent unsafe motion of the robot. In the case of automatic motion (without user-in the-loop), the system can be designed such that the robot controller’s robot software commands the desired motion without any user action through the bedside controller or robot workstation’s user software. In this scenario, a time delay may be added as a safety feature to allow user to perceive the motion.

[0216] In the present example, the robot controller’s robot software receives this signal and commands the desired motion to achieve the target carriage positions. The commanded motion is received by the motor driver which powers the motor to move. One example of one suchmotor driver is from Shinsei Corporation and one example of one such motor is a piezoelectric motor from Shinsei Corporation. Both the incremental encoder and absolute encoder are utilized to form a closed-loop control of the robot to achieve a highly precise motion compared to the targeted motion. It is understood that a wide variety of control schemes exist to accomplish this closed-loop control motion. One of such methods is the popular position- integral-derivative control method.

[0217] Once the rigid structure pose is achieved to facilitate alignment of guided insertable interventional instrument to the target trajectory, the robot retains the pose of the rigid structure allowing the user to insert the medical instrument through the guide and reach the target.Additional Example Embodiments

[0218] In some example embodiments, a medical robot system includes a robot manipulator and a robot controller. The robot manipulator includes a rigid structure (e.g. a rigid platform, which can include an integrated or attachable end effector), at least a pair of spaced apart rails, a plurality of carriage assemblies and a plurality of rigid members (links). The plurality of carriage assemblies are operably attached to the rails and distributed between the rails, and each carriage assembly has an actuator to independently drive the carriage assembly along the rail. Each rigid member is operably and pivotally attached between the rigid structure and one of the plurality of carriages.

[0219] The rails of the at least a pair of rails may be at an angle to each other. The rails of the at least a pair of rails may be parallel to each other. The rails of the at least a pair of rails may be straight.

[0220] The plurality of carriage assemblies may be six carriage assemblies and the plurality of rigid members may be six rigid members.

[0221] The rigid structure may have a distal end and a proximal end and two of the rigid members may be attached proximate to the distal end and four of the rigid members may be attached proximate to the proximal end. The rigid members at the distal end may be attached to the rigid structure symmetrically and the rigid members at the proximal end may be attached to the rigid structure asymmetrically. The rigid members at the distal end may be attached to the rigid structure symmetrically and the rigid members at the proximal end may be attached to the rigid structure symmetrically. The rigid members may be attached to the rigid structure and a pair of rigid members at the proximal end may be angled in the same direction and a pair of rigid members in the middle may be angled in the opposite direction.

[0222] Each carriage assembly may be slidably connected to one of the at least a pair of rails.

[0223] The actuator may be a rotary actuator operably connected to a gear train. The gear train may be operably attached to a rack and pinion. The rack may be positioned along the rails.

[0224] The gear train may be operably attached to a sleeve bearing. Alternatively, the gear train may be operably attached to track roller. Alternatively, the gear train may be operably attached to a ball bearing.

[0225] A plurality of ball joints may be used to connect each rigid member to the rigid structure and the carriage.

[0226] A patient support and the robot manipulator may be docked to the patient support. The patient support may have fiducials operably connected thereto.

[0227] The medical robot system may further include a bedside controller operably connected to the robot controller. The bedside controller may show a target trajectory and depth of insertion. The bedside controller may be configured to manually move the robot manipulator. The bedside controller may be configured to move the robot manipulator to the target trajectory.

[0228] The medical robot may further include a robot workstation operably connected to the robot controller and the robot workstation may be operably connected to a detector system.The detector system may be one of a camera, an X-ray system, a computed tomography system, a mammography system, a laser-induced fluorescence or auto-fluorescence system, an optical spectroscopy system, an ultrasound system, a magnetic resonance imaging (MRI) system, a positron emission tomography (PET) system, a positron emission mammography (PEM) system, a molecular breast imaging (MBI) system, a computed tomography (CT) laser mammography system, a molecular biological imager, a breast specific gamma imaging (BSGI) system or a sonography system.

[0229] The medical robot system may include a robot workstation operably connected to robot controller and the detector system. The detector system may be configured to acquire at least one image and wherein the robot workstation is configured to retrieve the at least one image from the detector system; register the at least one image in relation to the robot manipulator; and receive at least one user identified target on the at least one image.

[0230] The robot workstation may be configured to receive the at least one target and to calculate a target trajectory to reach the at least one target. The robot controller may be configured to calculate a target pose for the rigid structure. The robot controller may be configured to receive a command from a user to move the robot manipulator to the target trajectory and the target pose. The robot controller may receive the command from a bedside controller.

[0231] The rigid structure may be operably connected to a medical instrument. The medical instrument may be one of a biopsy tool, an ablation tool, a needle, a trocar, a probe, anultrasound probe, a fiber optic probe, a drug delivery tool, and a magnetic resonance imaging (MRI) coil.

[0232] Each carriage assembly may include a primary encoder and a secondary encoder. The primary encoder may be an incremental quadrature encoder. The second encoder may include a LED and a photodiode configured to measure the varying reflectivity of a gradient patten. The gradient pattern may include three different gradient patterns of increasing frequencies.

[0233] The medical robot system may be configured for use in prostate interventions. Alternatively, the medical robot system may be configured for use in one of cranial, liver, kidney bone or lung interventions.

[0234] A carriage assembly for use in a medical robot is for use with rigid member and a rail. The carriage assembly includes a rotary actuator, a gear train, a linear actuator and a linear stage. The geartrain is operably connected to the rotary actuator. The linear actuator is operably connected to the gear train. The linear actuator is operably connectable to the rail. The linear stage is operably connected to the rotary actuator and slidingly engaged to the rail.

[0235] The linear actuator may be a rack and pinion type actuator with the rack positioned along the rail.

[0236] The linear actuator may include a sleeve bearing. Alternatively, the linear actuator may include a track roller. Alternatively, the linear actuator may include a ball bearing.

[0237] The rigid member may be pivotally attached to the carriage assembly.

[0238] A pivot includes a socket base, a ball and a socket mount. The ball has a stud extending outwardly therefrom. The ball is slidingly sitting in the socket base. The socket mount has an asymmetric cut out attached to the socket base and the stud extends through the cut out.

[0239] An encoder is for use with a gradient pattern. The encoder includes an LED; and

[0240] a photodiode configured to measure varying reflectivity of the gradient pattern. The gradient pattern may include three different gradient patterns of increasing frequencies.Enumerated Embodiments

[0241] Embodiment 1 . A medical robotic system comprising: a patient support configured to support a patient such that an anatomical region of the patient is accessible; and a parallel kinematic robotic manipulator comprising: a base; a rigid structure;an end effector integrated with or attachable to the rigid structure, the end effector configured to facilitate insertion of a medical instrument along an insertion axis; a plurality of kinematic chains, each kinematic chain independently connecting the base to the rigid structure, wherein each kinematic chain comprises at least one link member and a plurality of joints, the plurality of joints including a distal rotational joint permitting angular movement between the kinematic chain and the rigid structure; and a drive system comprising a plurality of actuators, each actuator being operably coupled to a unique kinematic chain and independently controllable to actuate an active joint of the unique kinematic chain, the plurality of actuators being controllable to adjust a pose of the rigid structure relative to the base; the base being capable of mechanically docking with the patient support in a defined position and orientation for spatially registering the parallel kinematic robotic manipulator with the patient support; and the parallel kinematic robotic manipulator and the patient support being configured such that when the parallel kinematic robotic manipulator is docked with the patient support and the patient is supported by the patient support such that the anatomical region is accessible, the drive system is operable to achieve a pose of the rigid structure.

[0242] Embodiment 2. The medical robotic system according to embodiment 1 wherein the patient support is configured to support the patient such that the thighs of the patient are articulated to provide access to a pelvic region of the patient; and wherein the parallel kinematic robotic manipulator and the patient support are configured such that when the parallel kinematic robotic manipulator is docked with the patient support and the patient is supported by the patient support such that the pelvic region is accessible, at least a portion of the parallel kinematic robotic manipulator resides within an intermediate region accessible through a gap formed by articulation of the thighs

[0243] Embodiment 3. The medical robotic system of embodiment 2, wherein the patient support is an elongate patient support that defines a longitudinal direction and is structured to support the patient such a craniocaudal axis of the patient extends in the longitudinal direction.

[0244] Embodiment 4. The medical robotic system of embodiment 2, wherein the parallel kinematic robotic manipulator is sized such that a lateral width of the parallel kinematic robotic manipulator is constrained to reside between or under the articulated thighs of the patient when the patient is supported by the limb support features on the patient support.

[0245] Embodiment 5. The medical robotic system of embodiment 2, wherein a maximum lateral width of the parallel kinematic robotic manipulator is sized to be less than a minimum lateraldistance between the thighs of the patient when the patient resides on the patient support with the thighs supported in the articulated configuration by the limb support features.

[0246] Embodiment 6. The medical robotic system of embodiment 2, wherein the base and the patient support are cooperatively configured to facilitate the mechanical docking therebetween.

[0247] Embodiment 7. The medical robotic system of embodiment 6, wherein the base and the patient support each include at least one corresponding connecting feature, the corresponding connecting features on the base and the patient support being structured to releasably connect together so as to rigidly establish the defined position and orientation between the base and the patient support.

[0248] Embodiment 8. The medical robotic system of embodiment 7, wherein the corresponding structural features on the base and patient support are selected from the group comprising: a pin and socket mechanism, a rail and channel mechanism, a rigid alignment plate, and a quick-release latch.

[0249] Embodiment 9. The medical robotic system of embodiment 2, wherein the plurality of kinematic chains of the parallel kinematic robotic manipulator are structured such that when the parallel kinematic robotic manipulator is docked to the patient support at the defined position and orientation, a reachable workspace volume is defined for the end effector, the reachable workspace volume being partly superimposed over the pelvic region of the patient and being intersected by the insertion axis.

[0250] Embodiment 10. The medical robotic system of embodiment 9, wherein the patient support is an elongate patient support that defines a longitudinal direction and is structured to support the patient such a craniocaudal axis of the patient extends in the longitudinal direction, and wherein a transverse extent of the reachable workspace volume, in a direction perpendicular to the longitudinal direction, is less than a longitudinal extent of the reachable workspace volume.

[0251] Embodiment 1 1 . The medical robotic system of embodiment 10, wherein the plurality of kinematic chains are structured such that the reachable workspace volume has a generally cylindrical shape.

[0252] Embodiment 12. The medical robotic system of embodiment 3, wherein the patient support comprises a platform having a longitudinal support axis extending substantially along the longitudinal direction; and wherein the parallel kinematic robotic manipulator is structured such that when the base is docked with the patient support at the defined position and orientation, the end effector is held in a position and orientation, connected to the rigid structure, such that a projection of the insertion axis onto the longitudinal support axis is larger than a projection of the axis of insertion onto a plane perpendicular to the longitudinal support axis.

[0253] Embodiment 13. The medical robotic system of embodiment 3, wherein the patient support platform defines a longitudinal support axis extending substantially along the longitudinal direction; and wherein the parallel kinematic robotic manipulator is structured such that when the base is docked with the patient support at the defined position and orientation, the end effector is held in a position and orientation, connected to the rigid structure, such that the insertion axis has at least a primary directional component that is aligned with the longitudinal support axis.

[0254] Embodiment 14. The medical robotic system of embodiment 3, wherein the parallel kinematic robotic manipulator further comprises a housing that at least partially surrounds the plurality of kinematic chains; and wherein at least a portion of the housing is laterally tapered, relative to the longitudinal direction, to avoid contact with the thighs of the patient when the base is mechanically docked with the patient support and the patient resides on the patient support with the thighs supported in the articulated configuration.

[0255] Embodiment 15. The medical robotic system of embodiment 3, wherein the parallel kinematic robotic manipulator is configured as a slider-based parallel kinematic robotic manipulator such that the base includes a rail system comprising at least two spaced apart elongate rails, the rail system defining a proximal rail region and a distal rail region; the plurality of kinematic chains include a plurality of carriage assemblies configured to translate along the at least two elongate rails, the plurality of carriage assemblies being distributed between the at least two elongate rails such that each carriage assembly is movably connected to a respective one of the at least two elongate rails and each kinematic chain connects a respective carriage assembly to the rigid structure; wherein the parallel kinematic robotic manipulator and the patient support are configured such that when the parallel kinematic robotic manipulator is docked with the patient support, the rail system resides, at least in part, between the thighs of the patient and extends along the longitudinal direction with the distal rail region being disposed closer to the pelvic region than the proximal rail region.

[0256] Embodiment 16. The medical robotic system of embodiment 9, wherein the parallel kinematic robotic manipulator is configured such that, throughout a full range of motion of the end effector within the reachable workspace volume, no portion of the plurality of kinematic chains extends laterally beyond two vertical planes defined by laterally outermost edges of the at least two elongate rails.

[0257] Embodiment 17. The medical robotic system of embodiment 15, wherein each of the at least two elongate rails includes a proximal end in the proximal rail region and a distal end opposite the proximal end that is in the distal rail region.

[0258] Embodiment 18. The medical robotic system of embodiment 17, wherein the rail system includes only two spaced apart elongate rails which extend along the longitudinal direction of the patient support and are substantially parallel to one another and to said longitudinal direction.

[0259] Embodiment 19. The medical robotic system of embodiment 17, wherein the rail system includes only two spaced apart elongate rails, wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two spaced apart elongate rails; and wherein the two spaced apart elongate rails are oriented such that a longitudinal axis of each elongate rail bisects an axis that is parallel to the longitudinal direction to thereby define a V-rail pair.

[0260] Embodiment 20. The medical robotic system of embodiment 17, wherein the rail system includes only two spaced apart elongate rails, and wherein the two elongate rails are positioned at a non-zero angle relative to each other such that a lateral space between the distal ends of the two elongate rails is smaller than a lateral space between the proximal ends of the two elongate rails.

[0261] Embodiment 21. The medical robotic system of embodiment 17, wherein the at least two spaced apart elongate rails include at least four elongate rails; wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two elongate rails; and wherein the four elongate rails are symmetrically arranged and mirrored in pairs about the central bisecting plane to thereby define a proximal V-rail pair and a distal V-rail pair.

[0262] Embodiment 22. The medical robotic system of embodiment 21 , wherein a largest separation distance between the rails of the distal V-rail pair, in a direction orthogonal to the central bisecting plane, is greater than a largest separation distance between the rails of the proximal V-rail pair in said direction orthogonal to the central bisecting plane.

[0263] Embodiment 23. The medical robotic system of embodiment 22, wherein a smallest separation distance between the rails of the distal V-rail pair, in said direction orthogonal to the central bisecting plane, is greater than a smallest separation distance between the rails of the proximal V-rail pair in said direction orthogonal to the central bisecting plane.

[0264] Embodiment 24. The medical robotic system of embodiment 15 wherein a unique carriage assembly of the plurality of carriage assemblies is included within each kinematic chain; and wherein the link of each kinematic chain is operably connected between the rigid structure and the unique carriage assembly via the plurality of joints with at least one joint of the plurality of joints being connected at either end of the link.

[0265] Embodiment 25. The medical robotic system of embodiment 24, wherein the at least two spaced apart elongate rails includes two elongate rails which extend along the longitudinal direction of the patient support structure.

[0266] Embodiment 26. The medical robotic system of embodiment 25, wherein the plurality of kinematic chains comprises six kinematic chains such that the plurality of carriage assemblies includes six unique carriage assemblies; wherein a first set of three carriage assemblies of the plurality of carriage assemblies is movably coupled to the first elongate rail, and a second set of three different carriage assemblies of the plurality of carriage assemblies is movably coupled to the second elongate rail.

[0267] Embodiment 27. The medical robotic system of any one of embodiments 24 to 26, wherein a unique drive actuator of the plurality of drive actuators is provided on each carriage assembly of the plurality of carriage assemblies for independently driving the carriage assembly along the associated elongate rail.

[0268] Embodiment 28. The medical robotic system of embodiment 2, wherein the rigid structure has an elongate form with a proximal end and a distal end, the distal end being disposed closer to the distal rail region of rail system than the proximal end.

[0269] Embodiment 29. The medical robotic system according to embodiment 2, wherein the end effector is integrated with or attachable to the rigid structure such that the end effector resides remote from the proximal end of the rigid structure.

[0270] Embodiment 30. The medical robotic system of embodiment 29, wherein the rigid structure has a tapering form such that a width of the proximal end is greater than a width of the distal end.

[0271] Embodiment 31 . The medical robotic system of embodiment 28, wherein the at least one link member of each kinematic chain is an elongate member; and wherein the plurality of kinematic chains include at least four kinematic chains such that the elongate members of the plurality of kinematic chains include at least first, second, third, and fourth elongate members.

[0272] Embodiment 32. The medical robotic system of embodiment 31 , wherein the first and second elongate members are pivotably connected to the rigid structure at first and second connection locations remote from the proximal end; and wherein the third and fourth elongate members are pivotably connected to the rigid structure at third and fourth connection locations remote from the distal end.

[0273] Embodiment 33. The medical robotic system of embodiment 32, wherein a separation distance between first and second connection locations is less than separation distance between the third and fourth connection locations.

[0274] Embodiment 34. The medical robotic system of embodiment 32 or 33, wherein the plurality of kinematic chains include six kinematic chains such that the elongate members of the plurality of kinematic chains further include fifth and sixth elongate members; and wherein the fifth and sixth members are pivotably connected to the rigid structure at fifth and sixth connection locations remote from the distal end.

[0275] Embodiment 35. The medical robotic system of embodiment 32, wherein a separation distance between the first and second connection locations is less than a separation distance between the fifth and sixth connection locations.

[0276] Embodiment 36. The medical robotic system of embodiment 34 or 35, wherein the at least two spaced apart elongate rails includes two elongate rails which extend along the longitudinal direction of the patient support structure; and wherein the kinematic chains that include the third and fifth members are operably connected to a first of the two elongate rails; and wherein the kinematic chains that the fourth and sixth members are operably connected to a second of the two elongate rails.

[0277] Embodiment 37. The medical robotic system of embodiment 36, wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two elongate rails; and wherein the third and fifth members and the fourth and sixth members are asymmetrically arranged on either side of the central bisecting plane.

[0278] Embodiment 38. The medical robotic system of embodiment 3, further comprising control and processing circuitry comprising a processor and memory, the memory comprising instructions executable by the processor for performing operations comprising: individually control the actuation of each drive actuator of the plurality of drive actuators in the drive system.

[0279] Embodiment 39. The medical robotic system of embodiment 38, wherein the memory further comprises instructions executable by the processor for: controlling the drive system to align the insertion axis along a pre-defined target trajectory extending into the pelvic region of the patient.

[0280] Embodiment 40. The medical robotic system of embodiment 3, further comprising a controller configured to individually control the actuation of each of the plurality of drive actuators of the drive system.

[0281] Embodiment 41 . The medical robotic system of embodiment 40, wherein controller is configured to command the drive system to position the end effector in a pre-configured reference pose.

[0282] Embodiment 42. The medical robotic system of embodiment 40, wherein the base is slidably connectable atop the patient support in a configuration where the base is constrained in a transverse plane perpendicular to the longitudinal direction of the patient support while also being manually translatable relative to the patient support along the longitudinal direction; and wherein the medical robotic system further includes a locking feature that is actuatable to lock a longitudinal position of the base relative to the patient support.

[0283] Embodiment 43. The medical robotic system of embodiment 42, wherein the base is manually translatable relative along the longitudinal direction such that a distal end of the end effector can be brought into contact with an exposed pelvic surface on the pelvic region of the patient, while the end effector is held in the pre-configured reference pose; and wherein the locking feature is structured to be locked upon said contact to establish a known location of the exposed pelvic surface within a frame of reference of the parallel kinematic robotic manipulator.

[0284] Embodiment 44. The medical robotic system of embodiment 40, wherein the controller is configured to collectively control the actuation of each of the plurality of drive actuators such that when the parallel kinematic robotic manipulator is docked to the patient support at the defined position and orientation, a reachable workspace volume is defined for the end effector; and wherein the controller is configured to control the actuation of the plurality of drive actuators such that, throughout a full range of motion of the end effector within the reachable workspace volume, no portion of the plurality of kinematic chains extends laterally beyond two vertical planes defined by laterally outermost edges of the at least two elongate rails.

[0285] Embodiment 45. The medical robotic system of embodiment 40, further comprising a surface scanning imaging device that is registered to a frame of reference of the parallel kinematic robotic manipulator; wherein the controller is communicatively connected to the imaging device and is configured to control the surface scanning image device to acquire surface data of the pelvic region of the patient, the surface data of the pelvic region of the patient including at least part of the exposed pelvic surface.

[0286] Embodiment 46. The medical robotic system of embodiment 45, wherein the controller is configured to register the surface data from the surface scanning imaging device to a frame of reference of the parallel kinematic robotic manipulator.

[0287] Embodiment 47. The medical robotic system of embodiment 45, wherein the controller is configured to detect, within the surface data, a location of an exposed pelvic surface of the pelvic region of the patient relative to the parallel kinematic robotic manipulator, when the patient resides on the patient support with the thighs supported in the articulated configuration.

[0288] Embodiment 48. The medical robotic system of embodiment 45, wherein the controller is communicatively connected to the imaging device and is configured to define a trajectory for the end effector, based on the detected location of the exposed pelvic surface, the trajectory for the end effector being such that a distal end of the end effector is prevented from extending beyond the exposed pelvic surface.

[0289] Embodiment 49. The medical robotic system of embodiment 2, further comprising a pelvic surface locating feature that is integrated with or attachable to the patient support in a fixed, known pose relative to the defined position and orientation of the base; wherein the pelvic surface locating feature is configured to contact an exposed pelvic surface of the pelvic region of the patient to establish a known location of the exposed pelvic surface within a frame of reference of the parallel kinematic robotic manipulator, and wherein the medical robotic system is configured to limit motion of the parallel kinematic robotic manipulator based on the known location to prevent a distal end of the end effector from extending distally beyond the exposed pelvic surface.

[0290] Embodiment 50. The medical robotic system of embodiment 2 or 49, wherein the patient support comprises at least one of leg supports and thigh retractors.

[0291] Embodiment 51. The medical robotic system of embodiment 2, wherein the end effector comprises a guide structure defining a guide axis, and wherein the guide axis is collinear with the insertion axis to guide the medical instrument.

[0292] Embodiment 52. The medical robotic system of embodiment 2, wherein the end effector comprises the medical instrument; and wherein the medical instrument has a distal elongate portion configured to be inserted along the insertion axis.

[0293] Embodiment 53. The medical robotic system of embodiment 2, wherein the end effector comprises a support structure configured to releasably hold the medical instrument such that a distal elongate portion of the medical instrument is aligned with the insertion axis for insertion.

[0294] Embodiment 54. The medical robotic system of embodiment 2, wherein the parallel kinematic robotic manipulator is constructed substantially from non-ferromagnetic materials that are compatible with a magnetic resonance imaging (MRI) environment, and wherein the plurality of drive actuators comprise piezoelectric motors.

[0295] Embodiment 55. A parallel kinematic robotic manipulator comprising: a base having a rail system that includes at least a first elongate rail and a second elongate rail, each of the first and second elongate rails having a proximal end and a distal end opposite the proximal end; a rigid structure;an end effector integrated with or attachable to the rigid structure, the end effector being configured to facilitate insertion of a medical instrument along an insertion axis; a plurality of kinematic chains, each kinematic chain independently connecting the rail system of the base to the rigid structure, wherein each kinematic chain comprises at least one link and a plurality of joints, the plurality of joints including a distal rotational joint permitting angular movement between the kinematic chain and the rigid structure; and a drive system comprising a plurality of drive actuators, each drive actuator being operably coupled to a respective kinematic chain and controllable to actuate an active joint of the respective kinematic chain, the plurality of drive actuators being controllable to adjust a pose of the rigid structure relative to the base; wherein the first elongate rail and the second elongate rail extend generally along the same direction, but are oriented at a non-zero angle relative to one another such that a separation distance between the proximal ends of the first and second elongate rails is greater than a separation distance between the distal ends of the first and second elongate rails, the first and second elongate rails thereby defining a V-shaped tapered rail footprint.

[0296] Embodiment 56. A method of preparing a medical robotic system for a medical procedure, the method comprising: providing the medical robotic system according to embodiment 1 ; docking the parallel kinematic robotic manipulator with the patient support; supporting the patient with the patient support such that the anatomical region is accessible; while employing the patient support to support the patient, employing volumetric imaging system to obtain volumetric image data characterizing the anatomical region of the patient and one or more spatial features associated with the medical robotic system; identifying, in the volumetric image data, a target region within the anatomical region of the patient; employing the one or more spatial features to register a frame of reference of the volumetric image data with a frame of reference of the parallel kinematic robotic manipulator; employing the volumetric image data to define a trajectory, in a frame of reference of the parallel kinematic robotic manipulator, for insertion of the medical instrument into the patient, the trajectory intersecting the target region; determining a pose of the rigid structure for positioning and orienting the rigid structure such that the insertion axis of the end effector is aligned with the trajectory; and controlling the parallel kinematic robotic manipulator such that the rigid structure is positioned and oriented according to the determined pose.

[0297] Embodiment 57. The method according to embodiment 56 wherein the patient support is configured to support the patient such that the thighs of the patient are articulated to provide access to a pelvic region of the patient; and wherein the parallel kinematic robotic manipulator and the patient support are configured such that when the parallel kinematic robotic manipulator is docked with the patient support and the patient is supported is by the patient support such the pelvic region is accessible, at least a portion of the parallel kinematic robotic manipulator resides within an intermediate region accessible through a gap formed by articulation of the thighs.

[0298] Embodiment 58. The method according to embodiment 57 further comprising determining, in the frame of reference of the parallel kinematic robotic manipulator, a reference location corresponding to an exposed surface of the pelvic region; and wherein the determined pose of the rigid structure is further constrained such that when the rigid structure is positioned and oriented according to the determined pose, a distal end of the end effector contacts or resides adjacent to the reference location.

[0299] Embodiment 59. The method of embodiment 58, wherein controlling the parallel kinematic robotic manipulator comprises: driving the plurality of drive actuators to move the rigid structure from a current pose to the prescribed pose such that the distal end of the end effector remains within the intermediate region between the articulated thighs.

[0300] Embodiment 60. The method of embodiment 56, wherein employing the patient volumetric image data to define the trajectory comprises: displaying on a display device, at least one image of the pelvic region of the patient, the at least one image being generated based on the patient volumetric image data; receiving a first user input that identifies the target region within the at least one image of the pelvic region; determining, based at least on one or more kinematic constraints of the parallel kinematic robotic manipulator, a plurality of feasible trajectories within the orientation workspace of the end effector along which the medical instrument can be inserted to reach the target region; presenting the plurality of feasible trajectories on the display device; and receiving a second user input that selects the trajectory from the plurality of feasible trajectories.

[0301] Embodiment 61. The method of embodiment 60, wherein the plurality of feasible trajectories are presented on the display device superimposed on the at least one image of the pelvic region; and wherein the plurality of feasible trajectories are displayed as a cone-shaped array of trajectories that converge at the target region.

[0302] Embodiment 62. The method of embodiment 60, wherein determining the plurality of feasible trajectories further comprises: identifying, within the patient volumetric image data, one or more anatomical avoidance structures that the trajectory should not intersect with; and filtering possible trajectories defined within the orientation workspace to exclude any trajectories from the possible trajectories within the orientation workspace that intersect with the identified anatomical avoidance structures.

[0303] Embodiment 63. The method of embodiment 58, wherein the medical robotic system further comprises a pelvic surface locating feature that is integrated with or attachable to the patient support; and wherein determining the reference location comprises positioning the patient on the patient support such that the exposed surface of the pelvic region contacts the pelvic surface location feature and the exposed pelvic surface is thereby spatially registered to the frame of reference of the parallel kinematic robotic manipulator.

[0304] Embodiment 64. The method of embodiment 58, wherein the patient volumetric image data includes at least part of the exposed surface of the pelvic region; and wherein determining the reference location comprises identifying said at least part of the exposed surface of the pelvic region within the patient volumetric image data, and registering the patient volumetric image data to the frame of reference of the parallel kinematic robotic manipulator to establish a spatial position of the at least part of the exposed surface of the pelvic region within the frame of reference of the parallel kinematic robotic manipulator as the reference location.

[0305] Embodiment 65. The method of embodiment 58, wherein the medical robotic system further comprises a surface scanning imaging system, the surface scanning imaging system being secured in a known pose relative to at least one of the patient support and the base of the parallel kinematic robotic manipulator; and the surface scanning imaging system being configured to acquire surface image data of the pelvic region of the patient.

[0306] Embodiment 66. The method of embodiment 65, wherein determining the reference location comprises acquiring surface image data of the pelvic region of the patient via the surface scanning imaging system, said surface image data including surface image data for at least part of the exposed pelvis area; identifying the at least part of the exposed pelvic area in the surface image data; and registering the surface image data to the frame of reference of the parallel kinematic robotic manipulator to establish a spatial position of the exposed pelvic area within the frame of reference of the parallel kinematic robotic manipulator as the reference location.

[0307] Embodiment 67. The method of embodiment 58, wherein the patient support is an elongate patient support that defines a longitudinal direction therealong; wherein the base of the parallel kinematic robotic manipulator is slidably connectable atop the patient support in a configuration where the base is fixed relative to the patient support about a transverse plane that is perpendicular to the longitudinal direction of the patient support while being translatable relative to the patient support along the longitudinal direction;

[0308] Embodiment 68. The method of embodiment 67, wherein determining the reference location comprises: controlling the parallel kinematic robotic manipulator to position the rigid structure in a preconfigured reference pose; translating the parallel kinematic robotic manipulator along the longitudinal direction relative to the patient support, while maintaining the pre-configured reference pose, until the distal end of the end effector contacts or resides adjacent to the exposed surface of the pelvic region; and locking a longitudinal position of the parallel kinematic robotic manipulator relative to the patient support to establish a spatial position of the exposed surface of the pelvic area as the reference location.

[0309] Embodiment 69. The method of embodiment 64, wherein registering the patient volumetric image data to the frame of reference of the parallel kinematic robotic manipulator comprises: securing at least one localization fixture comprising a pattern of fiducial markers to at least one of the base and the rigid structure of the parallel kinematic robotic manipulator, wherein the fiducial markers are structured to be detectable within volumetric image data acquired by the volumetric imaging system; employing the volumetric imaging system to obtain localization volumetric image data that includes the at least one localization fixture therewithin; identifying the pattern of fiducial markers within the localization volumetric image data; calculating a coordinate transformation matrix that maps a coordinate space of the localization volumetric image data to the frame of reference of the parallel kinematic robotic manipulator; and applying said coordinate transformation matrix to map a coordinate space of the patient volumetric image data to the frame of reference of the parallel kinematic robotic manipulator.

[0310] Embodiment 70. The method of embodiment 56, further comprising registering a distal tip of the medical instrument to the frame of reference of the parallel kinematic robotic manipulator.

[0311] Embodiment 71. The method of embodiment 70, wherein registering the distal tip of the medical instrument comprises: connecting the medical instrument to the end effector; positioning the distal tip of the medical instrument at a known mechanical calibration datum that is on or connected to the patient support; and recording a pose of the rigid structure when the distal tip is at the known mechanical calibration datum to calculate a registration home vector for the rigid structure.

[0312] Embodiment 72. The method of embodiment 56, wherein the patient support includes at least one connecting feature for releasably mounting the patient support to a couch of a volumetric imaging system that is employed to acquire the volumetric image data such that the patient support is held at a fixed position and orientation relative to the volumetric imaging system.

[0313] Embodiment 73. The method of embodiment 56, wherein the patient support is defined by a couch of a volumetric imaging system that is employed to acquire the volumetric image data; and wherein the base of the parallel kinematic robotic manipulator includes at least one connecting feature for releasably mounting the base to the patient support such that parallel kinematic robotic manipulator is held at a fixed position and orientation relative to the volumetric imaging system.

[0314] Embodiment 74. The method of embodiment 56, wherein the patient volumetric image data comprises Magnetic Resonance (MR) data.

[0315] Embodiment 75. The method of embodiment 74, wherein providing the medical robotic system comprises providing a parallel kinematic robotic manipulator constructed substantially from non-ferromagnetic materials compatible with an MR environment.

[0316] Embodiment 76. The method of embodiment 57, wherein the patient support is an elongate patient support that defines a longitudinal direction and that is structured to support the patient along said longitudinal direction.

[0317] Embodiment 77. The method of embodiment 76, wherein the base includes a rail system having at least two spaced apart elongate rails, the rail system including a proximal rail region and a distal rail region; and wherein the parallel kinematic robotic manipulator and the patient support are configured such that when the parallel kinematic robotic manipulator is docked with the patient support, the rail system resides, at least in part, between the thighs of the patient and extends along the longitudinal direction with the distal rail region being disposed closer to the pelvic region than the proximal rail region.

[0318] Embodiment 78. The method of embodiment 77, wherein the plurality of kinematic chains of the parallel kinematic robotic manipulator are structured such that when the parallel kinematic robotic manipulator is docked to the patient support at the defined position and orientation, a reachable workspace volume is defined for the end effector, the reachable workspace volume being partly superimposed over the pelvic region of the patient and being intersected by the insertion axis.

[0319] Embodiment 79. The method of embodiment 78, wherein the plurality of kinematic chains are structured such that the reachable workspace volume has a longitudinal dimension that is substantially parallel to a longitudinal axis of the patient support; and wherein the longitudinal dimension of the reachable workspace volume is greaterthan a transverse dimension of the workspace volume, the transverse dimension being perpendicular to the longitudinal direction.

[0320] Embodiment 80. The method of embodiment 78, wherein the plurality of kinematic chains are structured such that the reachable workspace volume has a generally cylindrical shape.

[0321] Embodiment 81. The method of embodiment 76, wherein the parallel kinematic robotic manipulator is structured such that when the base is docked with the patient support at the defined position and orientation, the end effector is held in a position and orientation, connected to the rigid structure, such that a projection of the insertion axis onto the longitudinal support axis is larger than a projection of the axis of insertion onto a plane perpendicular to the longitudinal support axis.

[0322] Embodiment 82. The method of embodiment 76, wherein the patient support platform defines a longitudinal support axis extending substantially along the longitudinal direction; and wherein the parallel kinematic robotic manipulator is structured such that when the base is docked with the patient support at the defined position and orientation, the end effector is held in a position and orientation, connected to the rigid structure, such that the insertion axis has at least a primary directional component that is aligned with the longitudinal support axis.

[0323] Embodiment 83. The method of embodiment 78, wherein the robotic manipulator is configured such that, throughout a full range of motion of the end effector within the reachable workspace volume, no portion of the plurality of kinematic chains extends laterally beyond two vertical planes defined by laterally outermost edges of the at least two elongate rails.

[0324] Embodiment 84. The method of embodiment 77, wherein each of the at least two elongate rails includes a proximal end in the proximal rail region and a distal end opposite the proximal end that is in the distal rail region.

[0325] Embodiment 85. The method of embodiment 84, wherein the rail system includes only two spaced apart elongate rails which extend along the longitudinal direction of the patient support.

[0326] Embodiment 86. The method of embodiment 85, wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two elongate rails; and wherein the two elongate rails are symmetrically arranged and mirrored about the central bisecting plane to thereby define a V-rail pair.

[0327] Embodiment 87. The method of embodiment 85 or 86, wherein the two elongate rails are positioned at a non-zero angle relative to each other such that a lateral space between the distal ends of the two elongate rails is smallerthan a lateral space between the proximal ends of the two elongate rails.

[0328] Embodiment 88. The method of embodiment 86, wherein a first ofthe two elongate rails is positioned at a first angle relative to the central bisecting plane, and a second of the two elongate rails is positioned at a second angle relative to the central bisecting plane, and wherein the first angle and the second angle are substantially equal.

[0329] Embodiment 89. The method of embodiment 84, wherein the at least two spaced apart elongate rails include at least four elongate rails; wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two elongate rails; and wherein the four elongate rails are symmetrically arranged and mirrored in pairs about the central bisecting plane to thereby define a proximal V-rail pair and a distal V-rail pair.

[0330] Embodiment 90. The method of embodiment 89, wherein a largest separation distance between the rails ofthe distal V-rail pair, in a direction orthogonal to the central bisecting plane, is greater than a largest separation distance between the rails of the proximal V-rail pair in said direction orthogonal to the central bisecting plane; and wherein a smallest separation distance between the rails of the distal V-rail pair, in said direction orthogonal to the central bisecting plane, is greater than a smallest separation distance between the rails of the proximal V-rail pair in said direction orthogonal to the central bisecting plane.

[0331] Embodiment 91 . The method of embodiment 84, wherein the plurality of kinematic chains include a plurality of carriage assemblies that are configured to translate along the at least two elongate rails, the plurality of carriage assemblies being distributed between the at least two elongate rails such that each carriage assembly is movably connected to only one elongate rail.

[0332] Embodiment 92. The method of embodiment 91 , wherein the at least two spaced apart elongate rails includes two elongate rails which extend along the longitudinal direction of the patient support structure;wherein the plurality of kinematic chains comprises six kinematic chains; wherein a unique carriage assembly of the plurality of carriage assemblies is included within each kinematic chain such that the plurality of carriage assemblies includes six unique carriage assemblies; and wherein a first set of three carriage assemblies of the plurality of carriage assemblies is movably coupled to the first elongate rail, and a second set of three different carriage assemblies of the plurality of carriage assemblies is movably coupled to the second elongate rail.Additional Enumerated Embodiments

[0333] Embodiment 1. A medical robot system comprising: a robot manipulator having: a rigid structure, wherein an end effector is integrated with or attachable to the rigid structure; at least a pair of spaced apart rails; a plurality of carriage assemblies operably attached to the rails and distributed between the rails, and each carriage assembly having an actuator to independently drive the carriage assembly along the rail; a plurality of rigid members each rigid member being operably and pivotally attached between the rigid structure and one of the plurality of carriages; and a robot controller operably connected to the robot manipulator.

[0334] Embodiment 2. The medical robot system according to embodiment 1 wherein the rails of the at least a pair of rails are at an angle to each other.

[0335] Embodiment 3. The medical robot system according to embodiment 1 wherein the rails of the at least a pair of rails are parallel to each other.

[0336] Embodiment 4. The medical robot system according to embodiments 2 or 3 wherein the rails of the at least a pair of rails are straight.

[0337] Embodiment 5. The medical robot system according to any one of embodiments 1 to 4 wherein the plurality of carriage assemblies are six carriage assemblies and the plurality of rigid members are six rigid members.

[0338] Embodiment 6. The medical robot system according to embodiment 5 wherein the rigid structure has a distal end and a proximal end and two of the rigid members are attached proximate to the distal end and four of the rigid members are attached proximate to the proximal end.

[0339] Embodiment 7. The medical robot system according to embodiment 6 wherein the rigid members at the distal end are attached to the rigid structure symmetrically and the rigid members at the proximal end are attached to the rigid structure asymmetrically.

[0340] Embodiment 8. The medical robot system according to embodiment 6 wherein the rigid members at the distal end are attached to the rigid structure symmetrically and the rigid members at the proximal end are attached to the rigid structure symmetrically.

[0341] Embodiment 9. The medical robot system according to any one of embodiments 5 to 8 wherein rigid members are attached to the rigid structure and a pair of rigid members at the proximal end are angled in the same direction and a pair of rigid members in the middle are angled in the opposite direction.

[0342] Embodiment 10. The medical robot system according to any one of embodiments 1 to 9 wherein each carriage assembly is slidably connected to one of the at least a pair of rails.

[0343] Embodiment 11. The medical robot system according to any one of embodiments 1 to 10 wherein the actuator is a rotary actuator operably connected to a geartrain.

[0344] Embodiment 12. The medical robot system according to embodiment 11 wherein the geartrain is operably attached to a rack and pinion.

[0345] Embodiment 13. The medical robot system according to embodiment 12 wherein the rack is along the rails.

[0346] Embodiment 14. The medical robot system according to embodiment 11 wherein the geartrain is operably attached to a sleeve bearing.

[0347] Embodiment 15. The medical robot system according to embodiment 11 wherein the gear train is operably attached to track roller.

[0348] Embodiment 16. The medical robot system according to embodiment 11 wherein the geartrain is operably attached to a ball bearing.

[0349] Embodiment 17. The medical robot system according to any one of embodiments 1 to 9 further including a plurality of ball joints to connect each rigid member to the rigid structure and the carriage.

[0350] Embodiment 18. The medical robot system according to any one of embodiments 1 to 17 further including a patient support and the robot manipulator is docked to the patient support.

[0351] Embodiment 19. The medical robot system according to embodiment 18 wherein the patient support has fiducials operably connected thereto.

[0352] Embodiment 20. The medical robot system according to any one of embodiments 1 to 19 further including a bedside controller operably connected to the robot controller.

[0353] Embodiment 21. The medical robot system according to embodiment 20 wherein the bedside controller shows a target trajectory and depth of insertion.

[0354] Embodiment 22. The medical robot system according to embodiment 20 or 21 wherein the bedside controller is configured to manually move the robot manipulator.

[0355] Embodiment 23. The medical robot system according to embodiment 21 wherein the bedside controller is configured to move the robot manipulator to the target trajectory.

[0356] Embodiment 24. The medical robot system according to any one of embodiments 1 to 23 further including a robot workstation operably connected to the robot controller and the robot workstation is operably connected to a detector system.

[0357] Embodiment 25. The medical robot system according to embodiment 24 wherein the detector system is one of a camera, an X-ray system, a computed tomography system, a mammography system, a laser-induced fluorescence or auto-fluorescence system, an optical spectroscopy system, an ultrasound system, a magnetic resonance imaging (MRI) system, a positron emission tomography (PET) system, a positron emission mammography (PEM) system, a molecular breast imaging (MBI) system, a computed tomography (CT) laser mammography system, a molecular biological imager, a breast specific gamma imaging (BSGI) system or a sonography system.

[0358] Embodiment 26. The medical robot system according to embodiment 24 or 25 wherein the detector system is configured to acquire at least one image and wherein the robot workstation is configured to retrieve the at least one image from the detector system; register the at least one image in relation to the robot manipulator; and receive at least one user identified target on the at least one image.

[0359] Embodiment 27. The medical robot system according to embodiment 26 wherein the robot workstation is configured to receive the at least one target and to calculate a target trajectory to reach the at least one target.

[0360] Embodiment 28. The medical robot system according to embodiment 27 wherein the robot controller is configured to calculate a target pose for the rigid structure.

[0361] Embodiment 29. The medical robot system according to embodiment 28 wherein the robot controller is configured to receive a command from a user to move the robot manipulator to the target trajectory and the target pose.

[0362] Embodiment 30. The medical robot system according to embodiment 29 wherein the robot controller receives the command from a bedside controller.

[0363] Embodiment 31. The medical robot system according to any one of embodiments 1 to 30 wherein the rigid structure is operably connected to a medical instrument.

[0364] Embodiment 32. The medical robot system according to embodiment 31 wherein the medical instrument is one of a biopsy tool, an ablation tool, a needle, a trocar, a probe, an ultrasound probe, a fiber optic probe, a drug delivery tool, and a magnetic resonance imaging (MRI) coil.

[0365] Embodiment 33. The medical robot system according to any one of embodiments 1 to 32 wherein each carriage assembly includes a primary encoder and a secondary encoder.

[0366] Embodiment 34. The medical robot system according to embodiment 33 wherein the primary encoder is an incremental quadrature encoder.

[0367] Embodiment 35. The medical robot system according to embodiments 33 or 34 wherein the second encoder includes an LED and a photodiode configured to measure the varying reflectivity of a gradient patten.

[0368] Embodiment 36. The medical robot system according to embodiment 35 wherein the gradient pattern includes three different gradient patterns of increasing frequencies.

[0369] Embodiment 37. The medical robot system according to any one of embodiments 1 to 36 wherein the medical robot system is configured for use in prostate interventions.

[0370] Embodiment 38. The medical robot system according to any one of embodiments 1 to 37 wherein the medical robot system is configured for use in one of cranial, liver, kidney, bone or lung interventions.

[0371] Embodiment 39. A carriage assembly for use in a medical robot for use with a rigid member and a rail, the carriage assembly comprising: a rotary actuator; a gear train operably connect to the rotary actuator; a linear actuator operably connect to the gear train, the linear actuator being operably connectable to the rail; and a linear stage operably connected to the rotary actuator and slidingly engaged to the rail.

[0372] Embodiment 40. The carriage assembly according to embodiment 39 wherein the linear actuator is a rack and pinion type actuator and the rack is positioned is along the rail.

[0373] Embodiment 41. The carriage assembly according to embodiment 39 wherein the linear actuator includes a sleeve bearing.

[0374] Embodiment 42. The carriage assembly according to embodiment 39 wherein the linear actuator includes a track roller.

[0375] Embodiment 43. The carriage assembly according to embodiment 39 wherein the linear actuator includes a ball bearing.

[0376] Embodiment 44. The carriage assembly according to any one of embodiments 39 to 43 wherein the rigid member is pivotally attached to the carriage assembly.

[0377] Embodiment 45. A pivot comprising: a socket base, a ball with a stud extending outwardly therefrom, the ball slidingly sitting in the socket base; and a socket mount having an asymmetric cut out being attached to the socket base and the stud extending through the cut out.

[0378] Embodiment 46. An encoder for use with a gradient pattern, comprising; an LED; and a photodiode configured to measure varying reflectivity of the gradient pattern.

[0379] Embodiment 47. The encoder according to embodiment 46 wherein the gradient pattern includes three different gradient patterns of increasing frequencies.EXAMPLES

[0380] The following examples are presented to enable those skilled in the art to understand and to practice embodiments of the present disclosure. They should not be considered as a limitation on the scope of the disclosure, but merely as being illustrative and representative thereof.Example Robotic Manipulator Assembly with Example Needle Guide

[0381] The present example is provided as an additional, non-limiting working example of the medical robotic system 500 that includes the parallel kinematic robotic manipulator 502 (configured as a slider-based prismatically driven parallel kinematic robotic manipulator) to facilitate the positioning of the medical instrument, for example, for insertion into the prostate within the pelvic region of a patient.

[0382] An example of the medical robotic system 500 configured as the medical robotic system 1000 is shown in FIGS. 12 and 13, and includes the parallel kinematic robotic manipulator 502 configured as the parallel robotic manipulator 1010. In use, the patient support 503 is configured as patient support 1018 and is placed on top of an MRI table 1026. The patient (illustrated as patient 1016) is positioned supine on top of the patient support 1018 in semi-lithotomy position with the knees in a flexed position. The patient support 1018 contains MRI-visible fiducials 1028 that allows for registering it to the MRI images. The parallel robotic manipulator 1010 mechanically docks to the patient support 1018. It will be appreciated by those skilled in the art that the embodiment shown herein may be modified for alternate imaging system. As well, it may be modified for alternate patient positions or types of surgery.

[0383] The parallel robotic manipulator 1010 can be used to retain, position and enable insertion of a medical instrument (such as a biopsy needle, trocar, ablation needle, etc.) along a trajectory to reach the target region. This example embodiment was designed for transperineal approach for prostate interventions (e.g., biopsy and focal therapy such as cryoablation). The form factor of the parallel robotic manipulator 1010 enables it to be positioned under and between the legs of the patient. It will be appreciated that this may be used for a variety of different interventions, including surgical, diagnostic, treatment or drug delivery.

[0384] Referring to FIGS 14Ato 14F, the example parallel robotic manipulator 1010 is shown to contain the rigid structure 510 configured as rigid structure 1030, where the rigid structure 1030 can be positioned, relative to a base, in 6 degrees of freedom: translations along X, Y and Z-axis as well as rotation / angulator movement around X-axis (Yaw), Y-axis (Pitch) and Z-axis (Roll). Angular movements are important to allow physicians to achieve oblique trajectories to reach the lesions.

[0385] As illustrated below, the end effector 512 (such as a needle guide assembly), can be attached at the rigid structure 1030 (e.g. a distal end (front end) 1032 of the rigid structure 1030) that enables a physician to insert a medical instrument along the trajectory of the guide to reach the target location. The needle guide provides a conduit through which a medical instrument is inserted. In such an embodiment, the guide or conduit is rigidly and (and optionally removably) attached to the rigid structure such that the motion and position of the robot changes the orientation of the guide. The medical instrument may rest on the rigid structure and then be inserted through the needle guide as it slides on the rigid structure. Alternatively, the medical instrument may be inserted through the guide without resting on the rigid structure, and supported, for example by hand.

[0386] According to some non-limiting example implementations, the medical instrument can be a biopsy tool, an ablation tool, a needle, a trocar, a probe, an ultrasound probe, a fiber optic probe, a drug delivery tool, or a magnetic resonance imaging (MRI) coil. In the example embodiment shown in the present example, the rigid structure 1030 is tapered outwards towards the proximal end (back end) 1034 of the robot manipulator 1010. This increases stability in the movement of the rigid structure 1030. This also enables the parallel robot manipulator 1010 to fit between the legs of a patient. In the embodiment shown herein, the rigid structure 1030 follows the shape of the robot to keep the overall footprint of the robot small. It will be appreciated that the rigid structure 1030 can be any shape within or outside of the footprint of the rails as long as it attaches to the rigid members 1042 (which are example configurations of the link members 514) in the intended way. More specifically the rigid structure 1030 may be shaped for a specific purpose or type of surgery.

[0387] In the example implementation illustrated in the present example, the rigid structure 1030 is operably connected to the carriage assemblies 540 which are structured as six (6) carriages 1040 through six (6) rigid members 1042 via rotational pivots 1044 (which are example configurations of the pivot joints 516) on both ends of the rigid members 1042. These pivots 1044 allow for multi-axis rotations.

[0388] The pivots 1044 are positioned in two rows: one at the front or distal end 1032 and one at the rear or proximal end 1034 of the rigid structure 1030. The two rigid members 1042 connecting the two middle carriages 1040 are aligned in the opposite direction compared to theother four rigid members (i.e., the front two rigid members and rear two rigid members are facing forward while the middle rigid members are facing backward). This allows the rigid structure 1030 to retain its position under gravity. The pivots 1044 at the rear are positioned asymmetrical to increase stability in the movement of the rigid structure 1030. A pair of rigid members 1042 are attached to the rigid structure at the distal end of the rigid structure 1030 and a pair of rigid members at the proximal end of the rigid structure 1030 are angled in the same direction and a pair of rigid members in the middle are angled in the opposite direction. The pivots 1044 on the carriages are located very close to the rail surface to maximize the working volume of the robot manipulator 1010 within the overall volume thereof.

[0389] The at least two elongate rails 505 are formed as a pair of rails 1046, and the six carriages are mounted to the pair of rails 1046. Three carriages 1040 are mounted on each common rail. In the embodiment shown herein the pair of rails 1046 are straight and generally aligned in the Z-axis. They are at an angle to each other to enable the tapered shape of the parallel robot manipulator 1010.

[0390] The rails 1046 have an irregular profile to restrict motion and rotations in all but one linear axis. Alternatively, a pair of circular rails may be used to provide the same motion restrictions.

[0391] The rails 1046 are mounted to a common base of the parallel robot manipulator 1010. This is done to improve the alignment and stiffness of the parallel robot manipulator 1010. A protective enclosure 1050 (which is an example configuration of the housing 590) is mounted to the base of the parallel robot manipulator 1010, best seen in FIG. 14A. The rails 1046 and / or carriages 1040 are constructed from a non-metallic material. This minimizes impact to the MRI environment.

[0392] The parallel robot manipulator 1010 shown herein can achieve a wide range of positions. FIG. 15A shows a side view of the parallel robot manipulator 1010 without the enclosure 1050 and showing the farthest pitch up. In contrast FIG. 15B shows a top view of the parallel robot manipulator 1010 without the enclosure 1050 and showing farthest yaw (left or right side).

[0393] It will be appreciated by those skilled in the art that alternate configurations may be used when the parallel robotic manipulator 1010 is designed to be used for different types of interventions. The shape of the rigid structure 1030, the positioning of the rigid member attachments, the orientation and spacing of the rails may vary depending on the space constraints and the intended use of the parallel robotic manipulator 1010. FIGS. 16A and 16B and FIGS. 17Ato 17B show some alternate configurations.

[0394] Referring to FIGS. 16A and 16B, an alternate configuration of the parallel kinematic robotic manipulator 502 is shown as the robotic manipulator 1010'. Robotic manipulator 1010'is similar to that shown in FIGS. 14Ato 14F but the rails 1046 are parallel. Also, the rigid structure 1030 is generally rectangular. Accordingly, the space configuration of robotic manipulator 1010' is different than parallel robotic manipulator 1010.

[0395] Referring to FIGS. 17A and 17B, an alternate configuration of the parallel kinematic robotic manipulator 502 is shown as the robotic manipulator 1010". Robotic manipulator 1010" is similar to that shown in FIGS. 14Ato 14F but the pivots 1044 are attached in an alternate configuration. Pivots 1044 are attached in symmetrical configuration. The rigid members 1042 at the distal end are attached to the rigid structure 1030 symmetrically and the rigid members at the proximal end are attached to the rigid structure symmetrically.

[0396] Referring to FIGS. 18Ato 18C, each example carriage 1040 includes a linear stage 1052 with either low friction surfaces or rolling elements corresponding to the rail geometry. A carriage base 1051 is connected to the linear stage 1052. A carriage side plate 1053 is attached to the carriage base 1051. Each carriage 1040 is driven by a rotary actuator 1054, where the rotary actuators 1054 on each carriage 1040 form part of the drive system.

[0397] Each rotary actuator 1054 is attached to the carriage base 1051. The rotary actuator 1054 is operably connected to a geartrain 1056. This is to optimize the force / speed output. The rotary actuator 1054 with the geartrain 1056 drives the carriage 1040 linearly along the rail 1046 via a rack 1058 and pinion 1060. Two common racks 1058 are used. They provide independent movement for each carriage 1040. The racks 1058 are positioned on the outside (lateral) of the rails 1046. Alternatively, the racks 1058 may be machined into the rails 46 as an integrated feature.

[0398] Alternate embodiments of the carriage assembly 540 are shown in FIGS. 19Ato 19C. More specifically an embodiment of the carriage assembly 540 that is the carriage assembly 1040', shown in FIG. 19A includes a linear stage with a sleeve bearing 1080. An embodiment of the carriage assembly 540 that is the carriage assembly 1040", shown in FIG. 19B, includes a linear stage with track rollers 1082. Carriage assembly 1040", shown in FIG. 19C includes a linear stage with ball bearings 1084.

[0399] As shown in FIGS. 20A-20D, each rotational pivot 1044 is a ball and socket style joint. The spherical surface of the socket has been split into a mount (top half) 1070 and a base (bottom half) 1072 to enable manufacturing and assembly of these parts. The mount 1070 has an asymmetrical cutout 1074 to enable the full range of motion required for the robot (e.g. 20-70 degrees of rotation in the vertical plane and 0-55 degrees of rotation in the horizontal plane). The ball component 1076 of the joint is attached to a stud 1078 which is fastened to the ends of the rigid member 1042.

[0400] In the present example implementation, all pivots 1044 use common socket bases 1072 and ball studs 1076 but the socket mounts 1070 are mirrored to accommodate differentmounting angles for either side of the rails. The ball studs 1076 have been designed with hollow sections to enable consistent wall thicknesses for injection molding while minimizing the removal of material from the critical sliding interface. The ball and socket may be made of selflubricating materials with a low coefficient of friction to reduce maintenance requirements.

[0401] The rotary actuators 1054 and carriage contain encoders 1055. This enables closed loop control of the movement of the parallel robot manipulator 1010. The carriage 1040 contains electronics 1062 which consolidate readings from various sensors and relay this information to the central controller 1012.

[0402] The rotary actuators 1054 are connected to an incremental quadrature encoder to provide closed loop motion control. Each carriage assembly 1040 has a secondary absolute encoder to provide redundancy and determine the precise location of each carriage on the rails 1046.

[0403] As shown in FIGS. 21A-21C, the secondary absolute encoders 1089 enable initialization of the robot without requiring a homing procedure which would be complicated if multiple carriage assemblies 1040 are mounted to common rails. The multiple carriage assemblies 1040 on a common rail 1046 utilize independent sensors to measure a common gradient pattern allowing them to determine independent locations along the rail and also the relative spacing between carriages to prevent collisions. The secondary encoder 1089 utilizes an IR LED 90 and photodiode 1092 to measure the varying reflectivity of a gradient pattern 1094 which provides an analog output corresponding to a position along the rail. The positional accuracy is enhanced by using multiple sets of LEDs 1090 and photodiodes 1092 on each carriage to read multiple gradient patterns 94 with different frequencies. The multiple gradient patterns 1094 are spaced from the carriage assemblies 1040. In the embodiment shown herein the multiple gradient patterns 1094 include three distinct gradient patterns which are attached to the inside of the enclosure 50.

[0404] The lowest frequency pattern 1095 has a single white to black transition which provides a direct correlation for any given measurement to only one spot along the rail. The additional gradient patterns have increasing frequencies 1096 and 1097 respectively (i.e. they repeat white to black to white to black multiple times) to provide a bigger change in output signal for a given positional displacement, this makes the measurement less susceptible to noise and drift which increases the positional accuracy. This system is designed to be completely nonmagnetic and the use of optical sensors for absolute positioning as opposed to voltage or current measurements along a variable resistive element improve immunity in noisy environments.

[0405] FIG. 22 shows a flow diagram for the absolute encoders. In the embodiment shown herein, there are six absolute encoders, one for each carriage. Each absolute encoder includesat least one gradient pattern, a LED 1090 and photo diode 1092. In use, light is projected by the LED 1090 onto one of the gradient patterns 1094, it is then reflected back to the photo diode 1092. A microprocessor 1098 is operably and electronically connected to LED 90 and the photo diode 1092. The absolute position of the carriage 1040 is determined based on the value of the output of each of the photo diodes with regard to the different gradient patterns 1094.

[0406] It will be appreciated by those skilled in the art that the motors shown herein are rotary motors with rack and pinion drives. However, the rotary actuators may be mounted to each carriage and drive the carriage via a rack and pinion or high friction wheel or the actuators may be mounted to the robot base and drive the carriages via cable and pulleys, belts, or leadscrews. Alternatively, the carriages may be driven by piezo "walk type" actuators.The preceding figures of the present example illustrate an example robotic manipulator that is capable of securely receiving a needle guide, or another device, instrument or support.

[0407] The specific embodiments described above have been shown by way of example, and it should be understood that these embodiments may be susceptible to various modifications and alternative forms. It should be further understood that the claims are not intended to be limited to the particular forms disclosed, but rather to cover all modifications, equivalents, and alternatives falling within the spirit and scope of this disclosure.

Claims

CLAIMS1 . A medical robotic system comprising: a patient support configured to support a patient such that an anatomical region of the patient is accessible; and a parallel kinematic robotic manipulator comprising: a base; a rigid structure; an end effector integrated with or attachable to the rigid structure, the end effector configured to facilitate insertion of a medical instrument along an insertion axis; a plurality of kinematic chains, each kinematic chain independently connecting the base to the rigid structure, wherein each kinematic chain comprises at least one link member and a plurality of joints, the plurality of joints including a distal rotational joint permitting angular movement between the kinematic chain and the rigid structure; and a drive system comprising a plurality of actuators, each actuator being operably coupled to a unique kinematic chain and independently controllable to actuate an active joint of the unique kinematic chain, the plurality of actuators being controllable to adjust a pose of the rigid structure relative to the base; the base being capable of mechanically docking with the patient support in a defined position and orientation for spatially registering the parallel kinematic robotic manipulator with the patient support; and the parallel kinematic robotic manipulator and the patient support being configured such that when the parallel kinematic robotic manipulator is docked with the patient support and the patient is supported by the patient support such that the anatomical region is accessible, the drive system is operable to achieve a pose of the rigid structure.

2. The medical robotic system according to claim 1 wherein the patient support is configured to support the patient such that the thighs of the patient are articulated to provide access to a pelvic region of the patient; and wherein the parallel kinematic robotic manipulator and the patient support are configured such that when the parallel kinematic robotic manipulator is docked with the patient support and the patient is supported by the patient support such that the pelvic region is accessible, at least a portion of the parallel kinematic robotic manipulator resides within an intermediate region accessible through a gap formed by articulation of the thighs.

3. The medical robotic system of claim 2, wherein the patient support is an elongate patient support that defines a longitudinal direction and is structured to support the patient such a craniocaudal axis of the patient extends in the longitudinal direction.

4. The medical robotic system of claim 2, wherein the parallel kinematic robotic manipulator is sized such that a lateral width of the parallel kinematic robotic manipulator is constrained to reside between or under the articulated thighs of the patient when the patient is supported by the limb support features on the patient support.

5. The medical robotic system of claim 2, wherein a maximum lateral width of the parallel kinematic robotic manipulator is sized to be less than a minimum lateral distance between the thighs of the patient when the patient resides on the patient support with the thighs supported in the articulated configuration by the limb support features.

6. The medical robotic system of claim 2, wherein the base and the patient support are cooperatively configured to facilitate the mechanical docking therebetween.

7. The medical robotic system of claim 6, wherein the base and the patient support each include at least one corresponding connecting feature, the corresponding connecting features on the base and the patient support being structured to releasably connect together so as to rigidly establish the defined position and orientation between the base and the patient support.

8. The medical robotic system of claim 7, wherein the corresponding structural features on the base and patient support are selected from the group comprising: a pin and socket mechanism, a rail and channel mechanism, a rigid alignment plate, and a quick-release latch.

9. The medical robotic system of claim 2, wherein the plurality of kinematic chains of the parallel kinematic robotic manipulator are structured such that when the parallel kinematic robotic manipulator is docked to the patient support at the defined position and orientation, a reachable workspace volume is defined for the end effector, the reachable workspace volume being partly superimposed over the pelvic region of the patient and being intersected by the insertion axis.

10. The medical robotic system of claim 9, wherein the patient support is an elongate patient support that defines a longitudinal direction and is structured to support the patient such a craniocaudal axis of the patient extends in the longitudinal direction, and wherein a transverse extent of the reachable workspace volume, in a direction perpendicular to the longitudinal direction, is less than a longitudinal extent of the reachable workspace volume.11 . The medical robotic system of claim 10, wherein the plurality of kinematic chains are structured such that the reachable workspace volume has a generally cylindrical shape.

12. The medical robotic system of claim 3, wherein the patient support comprises a platform having a longitudinal support axis extending substantially along the longitudinal direction; and wherein the parallel kinematic robotic manipulator is structured such that when the base is docked with the patient support at the defined position and orientation, the end effector is held in a position and orientation, connected to the rigid structure, such that a projection of the insertion axis onto the longitudinal support axis is larger than a projection of the axis of insertion onto a plane perpendicular to the longitudinal support axis.

13. The medical robotic system of claim 3, wherein the patient support platform defines a longitudinal support axis extending substantially along the longitudinal direction; and wherein the parallel kinematic robotic manipulator is structured such that when the base is docked with the patient support at the defined position and orientation, the end effector is held in a position and orientation, connected to the rigid structure, such that the insertion axis has at least a primary directional component that is aligned with the longitudinal support axis.

14. The medical robotic system of claim 3, wherein the parallel kinematic robotic manipulator further comprises a housing that at least partially surrounds the plurality of kinematic chains; and wherein at least a portion of the housing is laterally tapered, relative to the longitudinal direction, to avoid contact with the thighs of the patient when the base is mechanically docked with the patient support and the patient resides on the patient support with the thighs supported in the articulated configuration.

15. The medical robotic system of claim 3, wherein the parallel kinematic robotic manipulator is configured as a slider-based parallel kinematic robotic manipulator such thatthe base includes a rail system comprising at least two spaced apart elongate rails, the rail system defining a proximal rail region and a distal rail region; the plurality of kinematic chains include a plurality of carriage assemblies configured to translate along the at least two elongate rails, the plurality of carriage assemblies being distributed between the at least two elongate rails such that each carriage assembly is movably connected to a respective one of the at least two elongate rails and each kinematic chain connects a respective carriage assembly to the rigid structure; wherein the parallel kinematic robotic manipulator and the patient support are configured such that when the parallel kinematic robotic manipulator is docked with the patient support, the rail system resides, at least in part, between the thighs of the patient and extends along the longitudinal direction with the distal rail region being disposed closer to the pelvic region than the proximal rail region.

16. The medical robotic system of claim 9, wherein the parallel kinematic robotic manipulator is configured such that, throughout a full range of motion of the end effector within the reachable workspace volume, no portion of the plurality of kinematic chains extends laterally beyond two vertical planes defined by laterally outermost edges of the at least two elongate rails.

17. The medical robotic system of claim 15, wherein each of the at least two elongate rails includes a proximal end in the proximal rail region and a distal end opposite the proximal end that is in the distal rail region.

18. The medical robotic system of claim 17, wherein the rail system includes only two spaced apart elongate rails which extend along the longitudinal direction of the patient support and are substantially parallel to one another and to said longitudinal direction.

19. The medical robotic system of claim 17, wherein the rail system includes only two spaced apart elongate rails, wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two spaced apart elongate rails; and wherein the two spaced apart elongate rails are oriented such that a longitudinal axis of each elongate rail bisects an axis that is parallel to the longitudinal direction to thereby define a V-rail pair.

20. The medical robotic system of claim 17, wherein the rail system includes only two spaced apart elongate rails, and wherein the two elongate rails are positioned at a non-zeroangle relative to each other such that a lateral space between the distal ends of the two elongate rails is smaller than a lateral space between the proximal ends of the two elongate rails.21 . The medical robotic system of claim 17, wherein the at least two spaced apart elongate rails include at least four elongate rails; wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two elongate rails; and wherein the four elongate rails are symmetrically arranged and mirrored in pairs about the central bisecting plane to thereby define a proximal V-rail pair and a distal V-rail pair.

22. The medical robotic system of claim 21 , wherein a largest separation distance between the rails of the distal V-rail pair, in a direction orthogonal to the central bisecting plane, is greater than a largest separation distance between the rails of the proximal V-rail pair in said direction orthogonal to the central bisecting plane.

23. The medical robotic system of claim 22, wherein a smallest separation distance between the rails of the distal V-rail pair, in said direction orthogonal to the central bisecting plane, is greater than a smallest separation distance between the rails of the proximal V-rail pair in said direction orthogonal to the central bisecting plane.

24. The medical robotic system of claim 15 wherein a unique carriage assembly of the plurality of carriage assemblies is included within each kinematic chain; and wherein the link of each kinematic chain is operably connected between the rigid structure and the unique carriage assembly via the plurality of joints with at least one joint of the plurality of joints being connected at either end of the link.

25. The medical robotic system of claim 24, wherein the at least two spaced apart elongate rails includes two elongate rails which extend along the longitudinal direction of the patient support structure.

26. The medical robotic system of claim 25, wherein the plurality of kinematic chains comprises six kinematic chains such that the plurality of carriage assemblies includes six unique carriage assemblies;wherein a first set of three carriage assemblies of the plurality of carriage assemblies is movably coupled to the first elongate rail, and a second set of three different carriage assemblies of the plurality of carriage assemblies is movably coupled to the second elongate rail.

27. The medical robotic system of any one of claims 24 to 26, wherein a unique drive actuator of the plurality of drive actuators is provided on each carriage assembly of the plurality of carriage assemblies for independently driving the carriage assembly along the associated elongate rail.

28. The medical robotic system of claim 2, wherein the rigid structure has an elongate form with a proximal end and a distal end, the distal end being disposed closer to the distal rail region of rail system than the proximal end.

29. The medical robotic system according to claim 2, wherein the end effector is integrated with or attachable to the rigid structure such that the end effector resides remote from the proximal end of the rigid structure.

30. The medical robotic system of claim 29, wherein the rigid structure has a tapering form such that a width of the proximal end is greater than a width of the distal end.31 . The medical robotic system of claim 28, wherein the at least one link member of each kinematic chain is an elongate member; and wherein the plurality of kinematic chains include at least four kinematic chains such that the elongate members of the plurality of kinematic chains include at least first, second, third, and fourth elongate members.

32. The medical robotic system of claim 31 , wherein the first and second elongate members are pivotably connected to the rigid structure at first and second connection locations remote from the proximal end; and wherein the third and fourth elongate members are pivotably connected to the rigid structure at third and fourth connection locations remote from the distal end.

33. The medical robotic system of claim 32, wherein a separation distance between first and second connection locations is less than separation distance between the third and fourth connection locations.

34. The medical robotic system of claim 32 or 33, wherein the plurality of kinematic chains include six kinematic chains such that the elongate members of the plurality of kinematic chains further include fifth and sixth elongate members; and wherein the fifth and sixth members are pivotably connected to the rigid structure at fifth and sixth connection locations remote from the distal end.

35. The medical robotic system of claim 32, wherein a separation distance between the first and second connection locations is less than a separation distance between the fifth and sixth connection locations.

36. The medical robotic system of claim 34 or 35, wherein the at least two spaced apart elongate rails includes two elongate rails which extend along the longitudinal direction of the patient support structure; and wherein the kinematic chains that include the third and fifth members are operably connected to a first of the two elongate rails; and wherein the kinematic chains that the fourth and sixth members are operably connected to a second of the two elongate rails.

37. The medical robotic system of claim 36, wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two elongate rails; and wherein the third and fifth members and the fourth and sixth members are asymmetrically arranged on either side of the central bisecting plane.

38. The medical robotic system of claim 3, further comprising control and processing circuitry comprising a processor and memory, the memory comprising instructions executable by the processor for performing operations comprising: individually control the actuation of each drive actuator of the plurality of drive actuators in the drive system.

39. The medical robotic system of claim 38, wherein the memory further comprises instructions executable by the processor for: controlling the drive system to align the insertion axis along a pre-defined target trajectory extending into the pelvic region of the patient.

40. The medical robotic system of claim 3, further comprising a controller configured to individually control the actuation of each of the plurality of drive actuators of the drive system.41 . The medical robotic system of claim 40, wherein controller is configured to command the drive system to position the end effector in a pre-configured reference pose.

42. The medical robotic system of claim 40, wherein the base is slidably connectable atop the patient support in a configuration where the base is constrained in a transverse plane perpendicular to the longitudinal direction of the patient support while also being manually translatable relative to the patient support along the longitudinal direction; and wherein the medical robotic system further includes a locking feature that is actuatable to lock a longitudinal position of the base relative to the patient support.

43. The medical robotic system of claim 42, wherein the base is manually translatable relative along the longitudinal direction such that a distal end of the end effector can be brought into contact with an exposed pelvic surface on the pelvic region of the patient, while the end effector is held in the pre-configured reference pose; and wherein the locking feature is structured to be locked upon said contact to establish a known location of the exposed pelvic surface within a frame of reference of the parallel kinematic robotic manipulator.

44. The medical robotic system of claim 40, wherein the controller is configured to collectively control the actuation of each of the plurality of drive actuators such that when the parallel kinematic robotic manipulator is docked to the patient support at the defined position and orientation, a reachable workspace volume is defined for the end effector; and wherein the controller is configured to control the actuation of the plurality of drive actuators such that, throughout a full range of motion of the end effector within the reachable workspace volume, no portion of the plurality of kinematic chains extends laterally beyond two vertical planes defined by laterally outermost edges of the at least two elongate rails.

45. The medical robotic system of claim 40, further comprising a surface scanning imaging device that is registered to a frame of reference of the parallel kinematic robotic manipulator; wherein the controller is communicatively connected to the imaging device and is configured to control the surface scanning image device to acquire surface data of the pelvicregion of the patient, the surface data of the pelvic region of the patient including at least part of the exposed pelvic surface.

46. The medical robotic system of claim 45, wherein the controller is configured to register the surface data from the surface scanning imaging device to a frame of reference of the parallel kinematic robotic manipulator.

47. The medical robotic system of claim 45, wherein the controller is configured to detect, within the surface data, a location of an exposed pelvic surface of the pelvic region of the patient relative to the parallel kinematic robotic manipulator, when the patient resides on the patient support with the thighs supported in the articulated configuration.

48. The medical robotic system of claim 45, wherein the controller is communicatively connected to the imaging device and is configured to define a trajectory for the end effector, based on the detected location of the exposed pelvic surface, the trajectory for the end effector being such that a distal end of the end effector is prevented from extending beyond the exposed pelvic surface.

49. The medical robotic system of claim 2, further comprising a pelvic surface locating feature that is integrated with or attachable to the patient support in a fixed, known pose relative to the defined position and orientation of the base; wherein the pelvic surface locating feature is configured to contact an exposed pelvic surface of the pelvic region of the patient to establish a known location of the exposed pelvic surface within a frame of reference of the parallel kinematic robotic manipulator, and wherein the medical robotic system is configured to limit motion of the parallel kinematic robotic manipulator based on the known location to prevent a distal end of the end effector from extending distally beyond the exposed pelvic surface.

50. The medical robotic system of claim 2 or 49, wherein the patient support comprises at least one of leg supports and thigh retractors.51 . The medical robotic system of claim 2, wherein the end effector comprises a guide structure defining a guide axis, and wherein the guide axis is collinear with the insertion axis to guide the medical instrument.

52. The medical robotic system of claim 2, wherein the end effector comprises the medical instrument; and wherein the medical instrument has a distal elongate portion configured to be inserted along the insertion axis.

53. The medical robotic system of claim 2, wherein the end effector comprises a support structure configured to releasably hold the medical instrument such that a distal elongate portion of the medical instrument is aligned with the insertion axis for insertion.

54. The medical robotic system of claim 2, wherein the parallel kinematic robotic manipulator is constructed substantially from non-ferromagnetic materials that are compatible with a magnetic resonance imaging (MRI) environment, and wherein the plurality of drive actuators comprise piezoelectric motors.

55. A parallel kinematic robotic manipulator comprising: a base having a rail system that includes at least a first elongate rail and a second elongate rail, each of the first and second elongate rails having a proximal end and a distal end opposite the proximal end; a rigid structure; an end effector integrated with or attachable to the rigid structure, the end effector being configured to facilitate insertion of a medical instrument along an insertion axis; a plurality of kinematic chains, each kinematic chain independently connecting the rail system of the base to the rigid structure, wherein each kinematic chain comprises at least one link and a plurality of joints, the plurality of joints including a distal rotational joint permitting angular movement between the kinematic chain and the rigid structure; and a drive system comprising a plurality of drive actuators, each drive actuator being operably coupled to a respective kinematic chain and controllable to actuate an active joint of the respective kinematic chain, the plurality of drive actuators being controllable to adjust a pose of the rigid structure relative to the base; wherein the first elongate rail and the second elongate rail extend generally along the same direction, but are oriented at a non-zero angle relative to one another such that a separation distance between the proximal ends of the first and second elongate rails is greater than a separation distance between the distal ends of the first and second elongate rails, the first and second elongate rails thereby defining a V-shaped tapered rail footprint.

56. A method of preparing a medical robotic system for a medical procedure, the method comprising: providing the medical robotic system according to claim 1 ; docking the parallel kinematic robotic manipulator with the patient support; supporting the patient with the patient support such that the anatomical region is accessible; while employing the patient support to support the patient, employing volumetric imaging system to obtain volumetric image data characterizing the anatomical region of the patient and one or more spatial features associated with the medical robotic system; identifying, in the volumetric image data, a target region within the anatomical region of the patient; employing the one or more spatial features to register a frame of reference of the volumetric image data with a frame of reference of the parallel kinematic robotic manipulator; employing the volumetric image data to define a trajectory, in a frame of reference of the parallel kinematic robotic manipulator, for insertion of the medical instrument into the patient, the trajectory intersecting the target region; determining a pose of the rigid structure for positioning and orienting the rigid structure such that the insertion axis of the end effector is aligned with the trajectory; and controlling the parallel kinematic robotic manipulator such that the rigid structure is positioned and oriented according to the determined pose.

57. The method according to claim 56 wherein the patient support is configured to support the patient such that the thighs of the patient are articulated to provide access to a pelvic region of the patient; and wherein the parallel kinematic robotic manipulator and the patient support are configured such that when the parallel kinematic robotic manipulator is docked with the patient support and the patient is supported is by the patient support such the pelvic region is accessible, at least a portion of the parallel kinematic robotic manipulator resides within an intermediate region accessible through a gap formed by articulation of the thighs.

58. The method according to claim 57 further comprising determining, in the frame of reference of the parallel kinematic robotic manipulator, a reference location corresponding to an exposed surface of the pelvic region; and wherein the determined pose of the rigid structure is further constrained such that when the rigid structure is positioned and oriented according to the determined pose, a distal end of the end effector contacts or resides adjacent to the reference location.

59. The method of claim 58, wherein controlling the parallel kinematic robotic manipulator comprises: driving the plurality of drive actuators to move the rigid structure from a current pose to the prescribed pose such that the distal end of the end effector remains within the intermediate region between the articulated thighs.

60. The method of claim 56, wherein employing the patient volumetric image data to define the trajectory comprises: displaying on a display device, at least one image of the pelvic region of the patient, the at least one image being generated based on the patient volumetric image data; receiving a first user input that identifies the target region within the at least one image of the pelvic region; determining, based at least on one or more kinematic constraints of the parallel kinematic robotic manipulator, a plurality of feasible trajectories within the orientation workspace of the end effector along which the medical instrument can be inserted to reach the target region; presenting the plurality of feasible trajectories on the display device; and receiving a second user input that selects the trajectory from the plurality of feasible trajectories.61 . The method of claim 60, wherein the plurality of feasible trajectories are presented on the display device superimposed on the at least one image of the pelvic region; and wherein the plurality of feasible trajectories are displayed as a cone-shaped array of trajectories that converge at the target region.

62. The method of claim 60, wherein determining the plurality of feasible trajectories further comprises: identifying, within the patient volumetric image data, one or more anatomical avoidance structures that the trajectory should not intersect with; and filtering possible trajectories defined within the orientation workspace to exclude any trajectories from the possible trajectories within the orientation workspace that intersect with the identified anatomical avoidance structures.

63. The method of claim 58, wherein the medical robotic system further comprises a pelvic surface locating feature that is integrated with or attachable to the patient support; andwherein determining the reference location comprises positioning the patient on the patient support such that the exposed surface of the pelvic region contacts the pelvic surface location feature and the exposed pelvic surface is thereby spatially registered to the frame of reference of the parallel kinematic robotic manipulator.

64. The method of claim 58, wherein the patient volumetric image data includes at least part of the exposed surface of the pelvic region; and wherein determining the reference location comprises identifying said at least part of the exposed surface of the pelvic region within the patient volumetric image data, and registering the patient volumetric image data to the frame of reference of the parallel kinematic robotic manipulator to establish a spatial position of the at least part of the exposed surface of the pelvic region within the frame of reference of the parallel kinematic robotic manipulator as the reference location.

65. The method of claim 58, wherein the medical robotic system further comprises a surface scanning imaging system, the surface scanning imaging system being secured in a known pose relative to at least one of the patient support and the base of the parallel kinematic robotic manipulator; and the surface scanning imaging system being configured to acquire surface image data of the pelvic region of the patient.

66. The method of claim 65, wherein determining the reference location comprises acquiring surface image data of the pelvic region of the patient via the surface scanning imaging system, said surface image data including surface image data for at least part of the exposed pelvis area; identifying the at least part of the exposed pelvic area in the surface image data; and registering the surface image data to the frame of reference of the parallel kinematic robotic manipulator to establish a spatial position of the exposed pelvic area within the frame of reference of the parallel kinematic robotic manipulator as the reference location.

67. The method of claim 58, wherein the patient support is an elongate patient support that defines a longitudinal direction therealong; wherein the base of the parallel kinematic robotic manipulator is slidably connectable atop the patient support in a configuration where the base is fixed relative to the patient support about a transverse plane that is perpendicular to the longitudinal direction of the patient support while being translatable relative to the patient support along the longitudinal direction;68. The method of claim 67, wherein determining the reference location comprises: controlling the parallel kinematic robotic manipulator to position the rigid structure in a pre-configured reference pose; translating the parallel kinematic robotic manipulator along the longitudinal direction relative to the patient support, while maintaining the pre-configured reference pose, until the distal end of the end effector contacts or resides adjacent to the exposed surface of the pelvic region; and locking a longitudinal position of the parallel kinematic robotic manipulator relative to the patient support to establish a spatial position of the exposed surface of the pelvic area as the reference location.

69. The method of claim 64, wherein registering the patient volumetric image data to the frame of reference of the parallel kinematic robotic manipulator comprises: securing at least one localization fixture comprising a pattern of fiducial markers to at least one of the base and the rigid structure of the parallel kinematic robotic manipulator, wherein the fiducial markers are structured to be detectable within volumetric image data acquired by the volumetric imaging system; employing the volumetric imaging system to obtain localization volumetric image data that includes the at least one localization fixture therewithin; identifying the pattern of fiducial markers within the localization volumetric image data; calculating a coordinate transformation matrix that maps a coordinate space of the localization volumetric image data to the frame of reference of the parallel kinematic robotic manipulator; and applying said coordinate transformation matrix to map a coordinate space of the patient volumetric image data to the frame of reference of the parallel kinematic robotic manipulator.

70. The method of claim 56, further comprising registering a distal tip of the medical instrument to the frame of reference of the parallel kinematic robotic manipulator.71 . The method of claim 70, wherein registering the distal tip of the medical instrument comprises: connecting the medical instrument to the end effector;positioning the distal tip of the medical instrument at a known mechanical calibration datum that is on or connected to the patient support; and recording a pose of the rigid structure when the distal tip is at the known mechanical calibration datum to calculate a registration home vector for the rigid structure.

72. The method of claim 56, wherein the patient support includes at least one connecting feature for releasably mounting the patient support to a couch of a volumetric imaging system that is employed to acquire the volumetric image data such that the patient support is held at a fixed position and orientation relative to the volumetric imaging system.

73. The method of claim 56, wherein the patient support is defined by a couch of a volumetric imaging system that is employed to acquire the volumetric image data; and wherein the base of the parallel kinematic robotic manipulator includes at least one connecting feature for releasably mounting the base to the patient support such that parallel kinematic robotic manipulator is held at a fixed position and orientation relative to the volumetric imaging system.

74. The method of claim 56, wherein the patient volumetric image data comprises Magnetic Resonance (MR) data.

75. The method of claim 74, wherein providing the medical robotic system comprises providing a parallel kinematic robotic manipulator constructed substantially from nonferromagnetic materials compatible with an MR environment.

76. The method of claim 57, wherein the patient support is an elongate patient support that defines a longitudinal direction and that is structured to support the patient along said longitudinal direction.

77. The method of claim 76, wherein the base includes a rail system having at least two spaced apart elongate rails, the rail system including a proximal rail region and a distal rail region; and wherein the parallel kinematic robotic manipulator and the patient support are configured such that when the parallel kinematic robotic manipulator is docked with the patient support, the rail system resides, at least in part, between the thighs of the patient and extends along the longitudinal direction with the distal rail region being disposed closer to the pelvic region than the proximal rail region.

78. The method of claim 77, wherein the plurality of kinematic chains of the parallel kinematic robotic manipulator are structured such that when the parallel kinematic robotic manipulator is docked to the patient support at the defined position and orientation, a reachable workspace volume is defined for the end effector, the reachable workspace volume being partly superimposed over the pelvic region of the patient and being intersected by the insertion axis.

79. The method of claim 78, wherein the plurality of kinematic chains are structured such that the reachable workspace volume has a longitudinal dimension that is substantially parallel to a longitudinal axis of the patient support; and wherein the longitudinal dimension of the reachable workspace volume is greater than a transverse dimension of the workspace volume, the transverse dimension being perpendicular to the longitudinal direction.

80. The method of claim 78, wherein the plurality of kinematic chains are structured such that the reachable workspace volume has a generally cylindrical shape.81 . The method of claim 76, wherein the parallel kinematic robotic manipulator is structured such that when the base is docked with the patient support at the defined position and orientation, the end effector is held in a position and orientation, connected to the rigid structure, such that a projection of the insertion axis onto the longitudinal support axis is larger than a projection of the axis of insertion onto a plane perpendicular to the longitudinal support axis.

82. The method of claim 76, wherein the patient support platform defines a longitudinal support axis extending substantially along the longitudinal direction; and wherein the parallel kinematic robotic manipulator is structured such that when the base is docked with the patient support at the defined position and orientation, the end effector is held in a position and orientation, connected to the rigid structure, such that the insertion axis has at least a primary directional component that is aligned with the longitudinal support axis.

83. The method of claim 78, wherein the robotic manipulator is configured such that, throughout a full range of motion of the end effector within the reachable workspace volume, no portion of the plurality of kinematic chains extends laterally beyond two vertical planes defined by laterally outermost edges of the at least two elongate rails.

84. The method of claim 77, wherein each of the at least two elongate rails includes a proximal end in the proximal rail region and a distal end opposite the proximal end that is in the distal rail region.

85. The method of claim 84, wherein the rail system includes only two spaced apart elongate rails which extend along the longitudinal direction of the patient support.

86. The method of claim 85, wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two elongate rails; and wherein the two elongate rails are symmetrically arranged and mirrored about the central bisecting plane to thereby define a V-rail pair.

87. The method of claim 85 or 86, wherein the two elongate rails are positioned at a non-zero angle relative to each other such that a lateral space between the distal ends of the two elongate rails is smaller than a lateral space between the proximal ends of the two elongate rails.

88. The method of claim 86, wherein a first of the two elongate rails is positioned at a first angle relative to the central bisecting plane, and a second of the two elongate rails is positioned at a second angle relative to the central bisecting plane, and wherein the first angle and the second angle are substantially equal.

89. The method of claim 84, wherein the at least two spaced apart elongate rails include at least four elongate rails; wherein the structure of the parallel kinematic robotic manipulator defines a central bisecting plane that is perpendicular to a plane containing the two elongate rails; and wherein the four elongate rails are symmetrically arranged and mirrored in pairs about the central bisecting plane to thereby define a proximal V-rail pair and a distal V-rail pair.

90. The method of claim 89, wherein a largest separation distance between the rails of the distal V-rail pair, in a direction orthogonal to the central bisecting plane, is greater than a largest separation distance between the rails of the proximal V-rail pair in said direction orthogonal to the central bisecting plane; andwherein a smallest separation distance between the rails of the distal V-rail pair, in said direction orthogonal to the central bisecting plane, is greater than a smallest separation distance between the rails of the proximal V-rail pair in said direction orthogonal to the central bisecting plane.91 . The method of claim 84, wherein the plurality of kinematic chains include a plurality of carriage assemblies that are configured to translate along the at least two elongate rails, the plurality of carriage assemblies being distributed between the at least two elongate rails such that each carriage assembly is movably connected to only one elongate rail.

92. The method of claim 91 , wherein the at least two spaced apart elongate rails includes two elongate rails which extend along the longitudinal direction of the patient support structure; wherein the plurality of kinematic chains comprises six kinematic chains; wherein a unique carriage assembly of the plurality of carriage assemblies is included within each kinematic chain such that the plurality of carriage assemblies includes six unique carriage assemblies; and wherein a first set of three carriage assemblies of the plurality of carriage assemblies is movably coupled to the first elongate rail, and a second set of three different carriage assemblies of the plurality of carriage assemblies is movably coupled to the second elongate rail.

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