Image‐guided robots for low dose rate prostate brachytherapy: Perspectives on safety in design and use

Abstract Background Image‐guided brachytherapy (BT) robots can be used to assist urologists during seed implantation, thereby improving therapeutic effects. However, safety issues must be considered in the design of such robots, including their structure, mechanical movements, function, materials and actuators. Previous reviews focused on image‐guided prostate BT robot technology (e.g., imaging and robot navigation technology and robot system introduction); however, this review is the first time that safety issues have been investigated as part of a study on low‐dose‐rate (LDR) prostate BT robots. Methods Multiple electronic databases were searched for LDR prostate BT robot articles published during the last 24 years (1996–2020), with a particular focus on two aspects of robots: safety in design and use. Results We retrieved a total of 26 LDR prostate BT robots. BT robots were divided into ultrasound, computed tomography, magnetic resonance imaging and fusion‐guided systems. The conditions associated with each system were then analysed to develop a set of requirements for the safety of prostate BT robots. Recommendations are also provided for future BT robot development. Conclusions The transrectal approach for prostate seed implantation is safer than the traditional transperineal approach. Research into the control of a steerable needle by the urologists and robot, the needle deflection model, and robotic automated needle changing and seed injection equipment should be pursued in a future study.