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Robotic Manipulator Shows Promise for Breast Examination

A concept of the future in which women would be able to call into their local pharmacy or health centre for a clinical breast exam (CBE) performed by a robot has been unveiled by scientists at the University of Bristol.

The device can apply "very specific forces over a range similar to forces used by human examiners", which, combined with sensor technology, can detect lumps at greater depths than before.

photo of clinical breast examination by device
Artist's impression of IRIS

The team, from the Bristol Robotics Laboratory , said their robotic manipulator could help to diagnose breast cancer earlier and "revolutionise how women monitor their breast health". Results from initial tests on the experimental device were presented at the end of August at the 2023 RO-MAN conference, a forum dedicated to robot and human interactive communication. 

Lead author George Jenkinson, a doctoral researcher in the lab, said tests so far had "laid all of the groundwork" for development of a system with the ability to perform CBE and diagnose breast cancer earlier. He explained that there were conflicting ideas about how useful CBE was, but it was generally agreed that if well performed it could be "a very useful and low risk diagnostic technique".

New Robot Enabled by Advances in Manipulation and Sensor Technology

There have been attempts in the past to use technology to improve CBE standards by having a robot or electronic device physically palpate breast tissue, but technological advances in manipulation and sensor technology over the last decade "mean that we are now in a better position to do this", Mr Jenkinson said.

The team created their manipulator, dubbed IRIS ( robotIc Radial palpatIon mechaniSm) using 3D printing and other computerised techniques. IRIS uses "a novel approach to achieve radial contraction and expansion, as well as control over the pitch of its tactile sensors at the contact region", the researchers explained.

They recruited a volunteer from the Simulation and Modelling in Medicine and Surgery research group at Imperial College London to cast and model a fake silicone breast and its digital twin, on which they could test the device using a combination of laboratory and simulated experiments.

Precision, repeatability, and accuracy are of "paramount importance" in these tactile medical examinations, the team said. Their simulations allowed them to perform thousands of palpations, and test multiple hypothetical scenarios, such as calculating the difference in efficiency when using two, three, or four sensors at the same time. Experiments on the silicone breast in the laboratory enabled them to demonstrate that the simulations were accurate, and to discover the forces required for the real manipulator.

Robot Shown to Have the Necessary Dexterity for CBE

Mr Jenkinson said their first question was whether a specialised manipulator could be shown to have the dexterity necessary to palpate a realistic breast size and shape. Their tests had demonstrated that the robotic system had "the dexterity necessary to carry out a CBE", which in future "could be a real help in diagnosing cancers early", he said.

"We hope that the research can contribute to and complement the arsenal of techniques used to diagnose breast cancer, and to generate a large amount of data associated with it that may be useful in trying to identify large scale trends that could help diagnose breast cancer early." 

One hope is that the device could provide a low-risk means for objective recording of health data, for example, to compare successive examinations more easily, or to offer baseline information for specialist referral. It has the potential to increase public accessibility to screening programmes, and research has suggested that the public would accept and engage with automated or robotic CBE, according to the scientists.

The ultimate goal is for the device and sensors to have the capability to detect lumps more accurately and deeply than is possible by human touch alone. It could also be combined with other existing techniques, such as ultrasound examination.

Innovative Diagnostic Techniques "Vital"

Asked to comment by Medscape News UK, Dr Kotryna Temcinaite, head of research communications at Breast Cancer Now, said: "Finding innovative ways to help diagnose breast cancer as early as possible is vital, and this new research is at an early stage of exploring if in future a robot device could potentially carry out a clinical breast exam, currently conducted by a healthcare professional. 

"While this study is the first to explore using five sensors in a stand-alone device, it has not been tested on people, and crucially there is no data suggesting it can detect new or unusual breast changes. Therefore, there's a lot more we need to understand before we can consider whether or not this device could ever be used in medical settings."

Also commenting to Medscape News UK, Dr Hattie Brooks, research information manager at Cancer Research UK, which helped fund the project, said: "Whilst this device is still early in its development and has yet to be tested on real people, initial results suggest its sensitivity and patterns of movement can accurately assess breast tissue."

She pointed out that breast cancer is the most common cancer in women in the UK, and diagnosing it earlier is key to improving outcomes. "Advances in technology like this are essential to driving progress," she said. "If successful, this device could be combined with other techniques that would help us detect breast cancer earlier, when treatment is more likely to be successful."

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