Overview

The objective of the iMIT (interactive Multi-Interventional Tool) program is to provide the technology that allows physicians to reach, diagnose and treat any organ with one single instrument. The iMIT program is organized around three research lines covering eleven projects. Together, these projects address the key challenges of combining miniaturized sensors and actions for a wide range of possible interactions between instrument and tissue.


Projects per research line:

  1. Basic technology: The projects in research line I solve fundamental problems related to the use of fibers during bending and force application (FIBER), steering and navigation (IMAGIC and MULTI), and fiber-electronics connections (CONNECT).
  2. Multi imaging on the instrument tip: The projects in research line II focus on capturing information about tissue properties using a variety of sensors at the instrument tip. To optimize the characterization of tissue properties, different approaches using photoacoustics (PARFAIT), OCT/DSP (PROSPECT), and FOCT/MFM (OBAMA) will be combined.
  3. Multi sensor/actuator on the instrument tip: The projects in research line III will realize mechanisms for instantly adapting the functionality of the instruments, by adapting stiffness based on sensor information (ADAPT), advancing catheters through an occlusion using steering and optical shape sensing (IGIT), penetrating tissue using ultra-thin needles (WASP), and achieving coagulation of vessels (LASER).

  • pFIBER

    Mechanical aspects of fiber optics

    iMIT focuses on developing instruments for minimally invasive care equipped with fiber optic technology. The mechanical effects of the fiber optics on measured tissue properties, such as resulting from mechanical pressure while touching tissue or from deforming while steering, are generally ignored, while this may have an tremendous influence on clinical outcome. Tissue properties (e.g. perfusion) may change when pushing with the fiber against tissue. The current project addresses these issues and aims to exploit the novel opportunities for measuring additional features of the tissue presented by the interaction between pressure and optical properties.

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  • pIMAGIC

    Intelligent image guidance in cardiac interventions

    In complex minimally invasive interventions, image guidance and visualization are often bottlenecks in the feedback loop of physician, instrument and patient. This project investigates generalized intelligent instrument & anatomy tracking and visualization to eliminate feedback limitations. These innovative concepts will be applied in two complex and clinically highly relevant minimally invasive procedures: radiofrequency ablation (RFA) treatment of atrial fibrillation, imaged with ultrasound, and treatment of chronic total occlusions (CTO) in coronary arteries, imaged with X-ray. In these procedures, novel fiber optics, ultrasound and instrument steering come together, in close collaboration with the corresponding iMIT projects.

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  • pMULTI

    Multi-steerable catheter

    Closed-chest surgery on the beating heart is one of the strong drives behind catheter development. Coronary artery balloon dilations form a golden standard, but complex cardiac catheter interventions are still rare. Main difficulties are the absence of vessel wall support, making it hard to position the catheter tip precisely, and the complex 3D shape of the ventricles requiring intricate catheter maneuvers that are impossible to carry out with existing designs. The added effect of blood flow and tissue motion caused by respiration and heartbeat makes it hard to use catheters for complex interventions such as mitral valve annuloplasty procedures and precision cardiac biopsies and transcatheter aortic-valve implantation (TAVI).

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  • pCONNECT

    Fiber Interconnect for Intelligent Guidewires

    There is an increasing trend to integrate electronic sensors on the tip of catheters and even guidewires, because it allows for the measurement of physical quantities like flow, pressure and vessel diameter exactly at the point of interest. Especially the integration of sensors on guide-wires is attractive because the wire is in most cases used anyway to guide other instruments to the point of intervention. The electrical wires in a guidewire (4 at the most due to space constraints) are unsuitable for the high-speed data communication needed. In this project we will address the transport of measurement data from the distal tip of a 360 µm diameter guidewire the instrument to the proximal side. 

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  • pPARFAIT

    Photoacoustic guidance of RF ablation for atrial fibrillation

    In the Netherlands alone, each year more than 50.000 percutaneous procedures are performed for treatment or removal of tissue from possibly diseased organs. Erroneous needle targeting can have disastrous effects for the patient. Also, in local treatment of cancer erroneous targeting can result in both reduced effectiveness of the therapy and damage to healthy tissue. In this project we will develop an instrument that addresses this issue through the first-ever combined use of two mechanical devices: a needle with adaptable stiffness and a probe that can identify tissues via real-time measurements of their stiffness.  

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  • pPROSPECT

    Spectroscopic biopsy of the prostate

    Prostate cancer is the most frequently occurring cancer in men, with an estimated 17000 patients in the Netherlands in 2020 (26% of all cancers). Due to improvements in early diagnostic techniques small tumors occupying less than 5-10% of the prostate volume can now be detected. These tumors are usually present at one location (unifocal) and are confirmed with physical biopsy and subsequent histopathological grade (aggressiveness) evaluation. Because of unclear demarcation of the lesion on presently available imaging techniques a biopsy-sampling protocol is required, in which 10-20 core-needle biopsies are taken. 

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  • pOBAMA

    Optical Biopsy: Anatomic Mapping and functional Analysis

    Despite improvements in early diagnosis and therapy, bladder cancer remains among the most expensive cancers in terms of patient quality-of-life and sustainability of health care costs. Adequate diagnostic modalities for early staging and grading of these tumors are lacking. Tissue biopsies obtained during transurethral resection are therefore necessary, but in over 45% of the cases a recurrence is developed. Moreover, due to heterogeneous presence of the tumor, large uncertainty exist in selecting biopsy sites, leading to large numbers of healthy tissue samples. Therefore, optimizing diagnostics is paramount. 

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  • pADAPT

    Fiber-top controlled adaptable stiffness needle

    In the Netherlands alone, each year more than 50.000 percutaneous procedures are performed for treatment or removal of tissue from possibly diseased organs. Erroneous needle targeting can have disastrous effects for the patient. Also, in local treatment of cancer by means of radiofrequency ablation, cryoablation, or radioactive seeds, erroneous targeting can result in both reduced effectiveness of the therapy and damage to healthy tissue. In this project we will develop an instrument that addresses this issue through the first-ever combined use of two mechanical devices: a needle with adaptable stiffness and a probe that can identify tissues via real-time measurements of their stiffness.  

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  • pIGIT

    Image Guided Interventional Treatment of Coronary Chronic Total Occlusion

    In the field on cardiovascular interventions, the chronic total occlusion (CTO) is a subset of lesion types that is the most challenging to treat, evidenced by the low procedural success (55%–80%) depending on the techniques and experience of the physician [16]. In comparison, the procedural success rate of non-occluded lesions is approximately 90%. The most important reason for this lower success rate is the fact that the lesion cannot be crossed by the guidewire. 

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  • pLASER

    DPS controlled laser coagulation needle

    Monochorionic (MC) twin pregnancies are at a 10% to 15% risk of developing twin-to-twin transfusion syndrome (TTTS), due to vascular anastomoses on a shared placenta, see figure. Before De Lia et al. proposed fetoscopic laser ablation of the placental vessels in 1990, serial amnioreduction was considered the only option for treatment of polyhydramnios, the most prominent feature of TTTS. Serial amnioreduction was associated with a double mortality rate of around 50%, a median gestational age at delivery around 28 weeks, and up to 50% major neurodevelopment impairment in survivors. 

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  • pWASP

    Ultra-thin steerable needle for solid- organ interventions

    After the success of minimally invasive techniques in abdominal surgery, the next challenge is to reach deep anatomical structures in a minimally WASPinvasive manner. Reaching deep anatomical locations requires a steerable flexible needle to manoeuvre around vessels, nerves, and other vulnerable structures. We approach the major challenge of manoeuvring a needle through complex solid organs with poorly known properties by considering an analogue found in nature: the ovipositor (egg-laying probe) of wasps (see Figure). 

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