Reflectance outperforms force and position in model-free needle puncture detection.

The surgical procedure of needle thoracostomy temporarily corrects accidental over-pressurization of the space between the chest wall and the lungs. However, failure rates of up to 94.1% have been reported, likely because this procedure is done blind: operators estimate by feel when the needle has reached its target. We believe instrumented needles could help operators discern entry into the target space, but limited success has been achieved using force and/or position to try to discriminate needle puncture events during simulated surgical procedures. We thus augmented our needle insertion system with a novel in-bore double-fiber optical setup. Tissue reflectance measurements as well as 3D force, torque, position, and orientation were recorded while two experimenters repeatedly inserted a bevel-tipped percutaneous needle into ex vivo porcine ribs. We applied model-free puncture detection to various filtered time derivatives of each sensor data stream offline. In the held-out test set of insertions, puncture-detection precision improved substantially using reflectance measurements compared to needle insertion force alone (3.3-fold increase) or position alone (11.6-fold increase).