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Cancer-fighting robots are great but still need a human touch

Commentary: Medical robots that improve breast cancer diagnosis should be celebrated, but their rise shouldn’t be at the expense of the patient's experience.

University of Twente

When we talk about robots, it's natural for your mind to turn to the kind of human-shaped droids you may have seen on the silver screen.

But many robots are more akin to machines that can operate independently, especially in the medical field. And they're the ones that often have the potential to impact our lives.

Such is the case with a robot called Stormram 4, a 3D-printed machine that can perform a biopsy, in which a piece of tissue is removed from under the skin. It's designed to address breast cancer, the most common form of cancer among women.

The key difference here is it can do so inside an MRI scanner, instead of during an ultrasound or mammogram. That change gives it "the highest precision compared to other imaging techniques used in the diagnostic phase of breast cancer patients," according to Françoise Siepel, one of the researchers working on the robot.

If you think that sounds great, you're not alone. The robot won the Surgical Robotic Challenge as part of UK Robotics Week at the end of June. But my own recent experience of undergoing an ultrasound-guided breast biopsy gives me cause to pause rather than immediately welcome the Stormram 4 with open arms. In working to improve the diagnostic aspect of the procedure, the robot may potentially remove one of the critical ingredients of care.

The human element

To begin with, a breast cancer biopsy is a serious matter. By the time you have the biopsy, a doctor has usually confirmed that yes, you aren't imagining it, there is something there and you don't know what it is. The biopsy is there to give you an answer, which you don't get straight away. But just the knowledge that an answer is coming, and that it might not be good, is worrisome.

Then there's the procedure itself. Even though I don't have a fear of needles, a biopsy needle is huge. It's not like the piddly needles used when you get a shot. I imagine that if it intimidates me, it would terrify others.

I didn't watch as the needle pierced my skin, but thanks to my kind radiologist, I did have the courage to watch it on the ultrasound screen. He told me exactly what we were both looking at and where he was putting the needle and why. He talked me through every step of the procedure, and explained exactly when and what I would experience as the needle captured the samples.

This is where my reservations come in. Having a human there to share and explain the procedure to me made what could have been a stressful experience feel bearable. At least, it was good to know when the needle was going to grab a bit of the (thankfully benign) tumor with a jolt that sounds and feels like being shot with a BB gun. It was also reassuring to have someone with me and guiding me the whole time.

There are forums devoted to questions and concerns from the procedure: How big is the needle? (Massive.) Does it hurt? (It didn't for me.) Does it scar? (Barely.) Does it bruise? (Yes.) Does it hurt afterward? (A little, but it's mainly just uncomfortable.)

Along with the number of women out there who are afraid of needles, there are also women who are claustrophobic and don't love the idea of MRI machines. Add to that the fear of receiving a life-changing diagnosis, and you have a potentially extremely nervous group of patients on your hands.

"We fully understand that taking a biopsy is a potential traumatic experience due to the uncertainty of the results and the needle insertion can be painful sometimes," said Siepel when I put my concerns to her. "During the MRI procedure the radiologist will talk you also through the procedure by using an audio link."

In addition, doctors recommend anesthetics.

It's reassuring to hear that the radiologist would be in your ear, even if that medical professional wouldn't physically be there right next to you. If I had the choice and both were equally capable of providing a correct result, I'd still go for the ultrasound-guided X-ray because a doctor is by my side.

But therein lies the problem -- they aren't equal. The MRI allows for much more accurate needle placement and a clearer image than ultrasound.

An assistant, not a replacement

As robots play an increasingly important role in modern medicine, it's important to keep in mind the patient's experience of interacting with that robot, as well as what that robot can do. Sandra Wachter, researcher in data ethics at the Alan Turing Institute, reassures me that through educational campaigns and a move toward embedding ethical values into research from the start, this is something roboticists are increasingly doing.

"I've talked to a lot of people working in this field and they are getting more and more aware of the ethical implications of their work," she said. "The mindset is shifting towards ethics, because we understand there is always an ethical component, especially when you are using machine learning and robotics in the health care system."

The main role for robots in medicine is as an assistive tool -- rather than replacing the doctor, they augment what the doctor is able to achieve. "Robotics can help us to make less invasive procedures, safer procedures, but there will always be a human in the loop to supervise," said Wachter.

Perhaps in the future, as robots become more common in surgical and other medical procedures, there may have to be some trade-off between patient experience and ensuring the best results, but let's hope it's kept to a minimum.

"If we always have the ethical mindset in place," said Wachter. "It will work."

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