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Zhang Y, Yuan Q, Muzzammil HM, Gao G, Xu Y. Image-guided prostate biopsy robots: A review. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:15135-15166. [PMID: 37679175 DOI: 10.3934/mbe.2023678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
At present, the incidence of prostate cancer (PCa) in men is increasing year by year. So, the early diagnosis of PCa is of great significance. Transrectal ultrasonography (TRUS)-guided biopsy is a common method for diagnosing PCa. The biopsy process is performed manually by urologists but the diagnostic rate is only 20%-30% and its reliability and accuracy can no longer meet clinical needs. The image-guided prostate biopsy robot has the advantages of a high degree of automation, does not rely on the skills and experience of operators, reduces the work intensity and operation time of urologists and so on. Capable of delivering biopsy needles to pre-defined biopsy locations with minimal needle placement errors, it makes up for the shortcomings of traditional free-hand biopsy and improves the reliability and accuracy of biopsy. The integration of medical imaging technology and the robotic system is an important means for accurate tumor location, biopsy puncture path planning and visualization. This paper mainly reviews image-guided prostate biopsy robots. According to the existing literature, guidance modalities are divided into magnetic resonance imaging (MRI), ultrasound (US) and fusion image. First, the robot structure research by different guided methods is the main line and the actuators and material research of these guided modalities is the auxiliary line to introduce and compare. Second, the robot image-guided localization technology is discussed. Finally, the image-guided prostate biopsy robot is summarized and suggestions for future development are provided.
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Affiliation(s)
- Yongde Zhang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin 150080, China
- Foshan Baikang Robot Technology Co., Ltd, Nanhai District, Foshan City, Guangdong Province 528225, China
| | - Qihang Yuan
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin 150080, China
| | - Hafiz Muhammad Muzzammil
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin 150080, China
| | - Guoqiang Gao
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin 150080, China
| | - Yong Xu
- Department of Urology, the Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing 100039, China
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Robot-Assisted Magnetic Resonance Imaging-Targeted versus Systematic Prostate Biopsy; Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15041181. [PMID: 36831524 PMCID: PMC9954527 DOI: 10.3390/cancers15041181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Robot-assisted devices have been recently developed for use in prostate biopsy. However, it is possible advantages over standard biopsy remain unclear. We aimed to assess the diagnostic performance and safety of robot-assisted targeted (RA-TB) and systematic prostate biopsies (RA-SB). METHODS A systematic literature search was performed in MEDLINE and Scopus databases. The detailed search strategy is available at Prospero (CRD42021269290). The primary outcome was the clinically significant prostate cancer (PCa) detection rate. The secondary outcomes included the overall detection rate of PCa, cancer detection rate per core, and complications. RESULTS The clinically significant cancer detection rate, overall cancer detection rate, and "per patient" did not significantly differ between RA-TB and RA-SB [OR = 1.02 (95% CI 0.83; 1.26), p = 0.05, I2 = 62% and OR = 0.95 (95% CI 0.78; 1.17), p = 0.17, I2 = 40%, respectively]. There were no differences in the clinically insignificant cancer detection rate "per patient" between RA-TB and RA-SB [OR = 0.81 (95% CI 0.54; 1.21), p = 0.31, I2 = 0%]. RA-TB had a significantly higher cancer detection rate "per core" [OR = 3.01 (95% CI 2.77; 3.27), p < 0.0001, I2 = 96%]. CONCLUSION RA-TB and RA-SB are both technically feasible and have comparable clinical significance and overall PCa detection rates.
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Peng C, Cai Q, Chen M, Jiang X. Recent Advances in Tracking Devices for Biomedical Ultrasound Imaging Applications. MICROMACHINES 2022; 13:mi13111855. [PMID: 36363876 PMCID: PMC9695235 DOI: 10.3390/mi13111855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 05/27/2023]
Abstract
With the rapid advancement of tracking technologies, the applications of tracking systems in ultrasound imaging have expanded across a wide range of fields. In this review article, we discuss the basic tracking principles, system components, performance analyses, as well as the main sources of error for popular tracking technologies that are utilized in ultrasound imaging. In light of the growing demand for object tracking, this article explores both the potential and challenges associated with different tracking technologies applied to various ultrasound imaging applications, including freehand 3D ultrasound imaging, ultrasound image fusion, ultrasound-guided intervention and treatment. Recent development in tracking technology has led to increased accuracy and intuitiveness of ultrasound imaging and navigation with less reliance on operator skills, thereby benefiting the medical diagnosis and treatment. Although commercially available tracking systems are capable of achieving sub-millimeter resolution for positional tracking and sub-degree resolution for orientational tracking, such systems are subject to a number of disadvantages, including high costs and time-consuming calibration procedures. While some emerging tracking technologies are still in the research stage, their potentials have been demonstrated in terms of the compactness, light weight, and easy integration with existing standard or portable ultrasound machines.
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Affiliation(s)
- Chang Peng
- School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China
| | - Qianqian Cai
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Mengyue Chen
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA
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Abstract
PURPOSE OF REVIEW The goal of this study is to review recent findings and evaluate the utility of MRI transrectal ultrasound fusion biopsy (FBx) techniques and discuss future directions. RECENT FINDINGS FBx detects significantly higher rates of clinically significant prostate cancer (csPCa) than ultrasound-guided systematic prostate biopsy (SBx), particularly in repeat biopsy settings. FBx has also been shown to detect significantly lower rates of clinically insignificant prostate cancer. In addition, a dedicated prostate MRI can assist in more accurately predicting the Gleason score and provide further information regarding the index cancer location, prostate volume, and clinical stage. The ability to accurately evaluate specific lesions is vital to both focal therapy and active surveillance, for treatment selection, planning, and adequate follow-up. FBx has been demonstrated in multiple high-quality studies to have improved performance in diagnosis of csPCa compared to SBx. The combination of FBx with novel technologies including radiomics, prostate-specific membrane antigen positron emission tomography (PSMA PET), and high-resolution micro-ultrasound may have the potential to further enhance this performance.
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Doyle AJ, Sullivan F, Walsh J, King DM, Cody D, Browne JE. Development and Preliminary Evaluation of an Anthropomorphic Trans-rectal Ultrasound Prostate Brachytherapy Training Phantom. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:833-846. [PMID: 33358053 DOI: 10.1016/j.ultrasmedbio.2020.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
The quality of the trans-rectal ultrasound (TRUS) image, and thus seed placement during the prostate brachytherapy (PBT) procedure, relies on the user's technical and clinical competency. Simulation-based medical education can provide a structured approach for the acquisition of clinical competencies, but the efficacy of the training relies on the fidelity of the training simulators. In this work, the design, development and preliminary evaluation of an anthropomorphic training phantom for TRUS PBT is described. TRUS clinical patient data informed the design of 3-D printed moulds to fabricate prostate targets. Tissue-mimicking materials were included that had the sonographic characteristics of the prostate and overlying tissues, as well as the clinically relevant physical response, to provide haptic feedback to the user. Through an iterative design process, prototypes were constructed. These prototypes were quantitatively evaluated using a specification list and evaluated by an experienced clinical brachytherapy oncologist; their feedback was implemented, and the results of this evaluation are presented.
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Affiliation(s)
- Andrea J Doyle
- School of Physics, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland; Health Professions Education Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Frank Sullivan
- Prostate Cancer Institute, National University of Ireland Galway, Galway, Ireland; Department of Radiotherapy, Galway Clinic, Galway, Ireland
| | - John Walsh
- School of Creative Arts, City Campus, Technological University Dublin, Dublin, Ireland
| | | | - Dervil Cody
- School of Physics, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland
| | - Jacinta E Browne
- School of Physics, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland; Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Bhanji Y, Allaway MJ, Gorin MA. Recent Advances and Current Role of Transperineal Prostate Biopsy. Urol Clin North Am 2020; 48:25-33. [PMID: 33218591 DOI: 10.1016/j.ucl.2020.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
"Approximately 1 million prostate biopsies are performed each year in the United States. This procedure has traditionally been performed using a transrectal approach, which is associated with a significant risk of infectious complications including sepsis. In recent years, transperineal prostate biopsy has been increasingly adopted due to its lower associated infectious risk. In this review, we explore the benefits of the transperineal approach for performing prostate biopsy and detail technical advancements that have allowed for this procedure to now be routinely performed in the outpatient settings under local anesthesia."
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Affiliation(s)
- Yasin Bhanji
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Marburg 134, Baltimore, MD 21287, USA
| | - Mathew J Allaway
- Urology Associates and UPMC Western Maryland, 12234 Williams Road, Cumberland, MD 21502, USA
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, 12234 Williams Road, Cumberland, MD 21502, USA.
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Kulkarni P, Sikander S, Biswas P, Frawley S, Song SE. Review of Robotic Needle Guide Systems for Percutaneous Intervention. Ann Biomed Eng 2019; 47:2489-2513. [PMID: 31372856 DOI: 10.1007/s10439-019-02319-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/02/2019] [Indexed: 01/24/2023]
Abstract
Numerous research groups in the past have designed and developed robotic needle guide systems that improve the targeting accuracy and precision by either providing a physical guidance for manual insertion or enabling a complete automated intervention. Here we review systems that have been reported in the last 11 years and limited to straight line needle interventions. Most systems fall under the category of image guided systems as they either use magnetic resonance image, computed tomography, ultrasound or a combination of these modalities for real time image feedback of the intervention path being followed. Actuation and control technology along with materials used for construction are the main aspects that differentiate these systems from each other and have been reviewed here. Image compatibility test details and results are also reviewed as they are used to ensure proper functioning of these systems under the respective imaging environments. We have also reviewed needle guide systems which either don't use any image feedback or have not reported any but provide physical guidance. Throughout this paper, we provide a comprehensive review of the technological aspects and trends in the field of robotic, straight line, needle guide intervention systems.
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Affiliation(s)
- Pankaj Kulkarni
- Department of Mechanical and Aerospace Engineering, University of Central Florida, 12760 Pegasus Dr., ENGR 1, Room 307, Orlando, FL, 32816-2450, USA
| | - Sakura Sikander
- Department of Mechanical and Aerospace Engineering, University of Central Florida, 12760 Pegasus Dr., ENGR 1, Room 307, Orlando, FL, 32816-2450, USA
| | - Pradipta Biswas
- Department of Mechanical and Aerospace Engineering, University of Central Florida, 12760 Pegasus Dr., ENGR 1, Room 307, Orlando, FL, 32816-2450, USA
| | - Shawn Frawley
- Department of Mechanical and Aerospace Engineering, University of Central Florida, 12760 Pegasus Dr., ENGR 1, Room 307, Orlando, FL, 32816-2450, USA
| | - Sang-Eun Song
- Department of Mechanical and Aerospace Engineering, University of Central Florida, 12760 Pegasus Dr., ENGR 1, Room 307, Orlando, FL, 32816-2450, USA.
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Antico M, Sasazawa F, Wu L, Jaiprakash A, Roberts J, Crawford R, Pandey AK, Fontanarosa D. Ultrasound guidance in minimally invasive robotic procedures. Med Image Anal 2019; 54:149-167. [DOI: 10.1016/j.media.2019.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/01/2019] [Accepted: 01/09/2019] [Indexed: 12/20/2022]
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Chen K, Tay KJ, Law YM, Aydin H, Ho H, Cheng C, Yuen JSP. Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance. Asian J Urol 2017; 5:184-193. [PMID: 29988897 PMCID: PMC6033238 DOI: 10.1016/j.ajur.2017.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/03/2016] [Accepted: 04/25/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Active surveillance (AS) offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer. An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place. We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging (MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer. Methods This prospective, single-blinded study included men with low-risk prostate cancer (D'Amico's Criteria) diagnosed on conventional transrectal ultrasound-guided biopsy. Patients first underwent multiparametric MRI of the prostate ≥6 weeks after initial biopsy. Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System (PIRADS) score. Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform. Results The age of the 19 men included is 65.4 ± 4.9 years (mean ± SD). Prostate specific antigen (PSA) at diagnosis and at the time of transperineal biopsy were comparable (7.3 ± 1.7 ng/mL and 7.0 ± 1.8 ng/mL, p = 0.67), so were prostate volumes (34.2 ± 8.9 mL and 32.1 ± 13.4 mL, p = 0.28). MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy (11.7% vs. 6.5%, p = 0.02), this was more than 3 times superior for Gleason 7 disease (5.9% vs. 1.6%, p < 0.01). Four of 18 (22.2%) patients with MRI lesions had significant disease with MRI-targeted biopsy alone. Three of 19 patients (15.8%) had significant disease with template biopsy alone. In combination, both techniques upclassified five patients (26.3%), all of whom underwent radical prostatectomy. Whole mount histology confirmed tumour location and grade. All six patients with PIRADS 5 lesions had cancer detected (66.6% significant disease). Conclusion A combination of MRI-targeted and template biopsy may optimally risk-classify “low-risk” patients diagnosed on initial conventional transrectal ultrasonography (TRUS) prostate biopsy.
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Affiliation(s)
- Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Hakan Aydin
- Department of Pathology, Singapore General Hospital, Singapore
| | - Henry Ho
- Department of Urology, Singapore General Hospital, Singapore
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Chang D, Chong X, Kim C, Jun C, Petrisor D, Han M, Stoianovici D. Geometric systematic prostate biopsy. MINIM INVASIV THER 2016; 26:78-85. [PMID: 27760001 DOI: 10.1080/13645706.2016.1249890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The common sextant prostate biopsy schema lacks a three-dimensional (3D) geometric definition. The study objective was to determine the influence of the geometric distribution of the cores on the detection probability of prostate cancer (PCa). METHODS The detection probability of significant (>0.5 cm3) and insignificant (<0.2 cm3) tumors was quantified based on a novel 3D capsule model of the biopsy sample. The geometric distribution of the cores was optimized to maximize the probability of detecting significant cancer for various prostate sizes (20-100cm3), number of biopsy cores (6-40 cores) and biopsy core lengths (14-40 mm) for transrectal and transperineal biopsies. RESULTS The detection of significant cancer can be improved by geometric optimization. With the current sextant biopsy, up to 20% of tumors may be missed at biopsy in a 20 cm3 prostate due to the schema. Higher number and longer biopsy cores are required to sample with an equal detection probability in larger prostates. Higher number of cores increases both significant and insignificant tumor detection probability, but predominantly increases the detection of insignificant tumors. CONCLUSION The study demonstrates mathematically that the geometric biopsy schema plays an important clinical role, and that increasing the number of biopsy cores is not necessarily helpful.
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Affiliation(s)
- Doyoung Chang
- a Robotics Laboratory, Urology Department, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Xue Chong
- a Robotics Laboratory, Urology Department, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Chunwoo Kim
- a Robotics Laboratory, Urology Department, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Changhan Jun
- a Robotics Laboratory, Urology Department, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Doru Petrisor
- a Robotics Laboratory, Urology Department, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Misop Han
- a Robotics Laboratory, Urology Department, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Dan Stoianovici
- a Robotics Laboratory, Urology Department, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
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Aalamifar F, Khurana R, Cheng A, Guo X, Iordachita I, Boctor EM. Enabling technologies for robot assisted ultrasound tomography. Int J Med Robot 2016; 13. [PMID: 27028676 DOI: 10.1002/rcs.1746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/06/2022]
Abstract
Currently available ultrasound (US) tomography systems suggest utilizing cylindrical transducers that can be used for a specific organ. In this paper, our focus is on an alternative way of creating US tomographic images that could be used for other anatomies and more general applications. This system consists of two conventional US probes facing each other while one or several of the transducers in one probe can act as the transmitter and the rest as the receiver. Aligning the two US probes is a challenging task. To address this issue, we propose a robot assisted US tomography system in which one probe is operated freehanded and another by a robotic arm. In this paper, enabling technologies for this system are described. With the current prototype, a reconstruction precision of 4.12, 1.73, and 2.23 mm for the three calibrations, and an overall alignment repeatability in the range of 5-9 mm were achieved. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Fereshteh Aalamifar
- Johns Hopkins University, Electrical & Computer Eng. Dept., 3400 N. Charles St., Baltimore, MD, 21218, USA
| | - Rishabh Khurana
- Johns Hopkins University, Mechanical Eng. Dept., 3400 N. Charles St., Baltimore, MD, 21218, USA
| | - Alexis Cheng
- Johns Hopkins University, Dept. of Computer Science., 3400 N. Charles St., Baltimore, MD, 21218, USA
| | - Xiaoyu Guo
- Johns Hopkins University, Electrical & Computer Eng. Dept., 3400 N. Charles St., Baltimore, MD, 21218, USA
| | - Iulian Iordachita
- Johns Hopkins University, Mechanical Eng. Dept., 3400 N. Charles St., Baltimore, MD, 21218, USA
| | - Emad M Boctor
- Johns Hopkins University, Electrical & Computer Eng. Dept., 3400 N. Charles St., Baltimore, MD, 21218, USA.,Johns Hopkins University, Dept. of Computer Science., 3400 N. Charles St., Baltimore, MD, 21218, USA.,Johns Hopkins University, Dept. of Radiology, 601 North Caroline Street., Baltimore, MD, 21287, USA
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Abdullah BJJ, Yeong CH, Goh KL, Yoong BK, Ho GF, Yim CCW, Kulkarni A. Robotic-assisted thermal ablation of liver tumours. Eur Radiol 2014; 25:246-57. [PMID: 25189152 DOI: 10.1007/s00330-014-3391-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/20/2014] [Accepted: 08/07/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to assess the technical success, radiation dose, safety and performance level of liver thermal ablation using a computed tomography (CT)-guided robotic positioning system. METHODS Radiofrequency and microwave ablation of liver tumours were performed on 20 patients (40 lesions) with the assistance of a CT-guided robotic positioning system. The accuracy of probe placement, number of readjustments and total radiation dose to each patient were recorded. The performance level was evaluated on a five-point scale (5-1: excellent-poor). The radiation doses were compared against 30 patients with 48 lesions (control) treated without robotic assistance. RESULTS Thermal ablation was successfully completed in 20 patients with 40 lesions and confirmed on multiphasic contrast-enhanced CT. No procedure related complications were noted in this study. The average number of needle readjustment was 0.8 ± 0.8. The total CT dose (DLP) for the entire robotic assisted thermal ablation was 1382 ± 536 mGy.cm, while the CT fluoroscopic dose (DLP) per lesion was 352 ± 228 mGy.cm. There was no statistically significant (p > 0.05) dose reduction found between the robotic-assisted versus the conventional method. CONCLUSION This study revealed that robotic-assisted planning and needle placement appears to be safe, with high accuracy and a comparable radiation dose to patients. KEY POINTS • Clinical experience on liver thermal ablation using CT-guided robotic system is reported. • The technical success, radiation dose, safety and performance level were assessed. • Thermal ablations were successfully performed, with an average performance score of 4.4/5.0. • Robotic-assisted ablation can potentially increase capabilities of less skilled interventional radiologists. • Cost-effectiveness needs to be proven in further studies.
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Affiliation(s)
- Basri Johan Jeet Abdullah
- Department of Biomedical Imaging and University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia,
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Ukimura O. Evolution of precise and multimodal MRI and TRUS in detection and management of early prostate cancer. Expert Rev Med Devices 2014; 7:541-54. [PMID: 20583890 DOI: 10.1586/erd.10.24] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Osamu Ukimura
- Kyoto Prefectural University of Medicine, Kyoto, Japan.
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14
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Stoianovici D, Kim C, Schäfer F, Huang CM, Zuo Y, Petrisor D, Han M. Endocavity Ultrasound Probe Manipulators. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2013; 18:914-921. [PMID: 24795525 PMCID: PMC4005376 DOI: 10.1109/tmech.2012.2195325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We developed two similar structure manipulators for medical endocavity ultrasound probes with 3 and 4 degrees of freedom (DoF). These robots allow scanning with ultrasound for 3-D imaging and enable robot-assisted image-guided procedures. Both robots use remote center of motion kinematics, characteristic of medical robots. The 4-DoF robot provides unrestricted manipulation of the endocavity probe. With the 3-DoF robot the insertion motion of the probe must be adjusted manually, but the device is simpler and may also be used to manipulate external-body probes. The robots enabled a novel surgical approach of using intraoperative image-based navigation during robot-assisted laparoscopic prostatectomy (RALP), performed with concurrent use of two robotic systems (Tandem, T-RALP). Thus far, a clinical trial for evaluation of safety and feasibility has been performed successfully on 46 patients. This paper describes the architecture and design of the robots, the two prototypes, control features related to safety, preclinical experiments, and the T-RALP procedure.
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Affiliation(s)
- Dan Stoianovici
- Urology Robotics Laboratory, School of Medicine, The Johns Hopkins University, Baltimore, MD 21224 USA
| | - Chunwoo Kim
- Urology Robotics Laboratory, School of Medicine, The Johns Hopkins University, Baltimore, MD 21224 USA
| | - Felix Schäfer
- Urology Robotics Laboratory, School of Medicine, The Johns Hopkins University, Baltimore, MD 21224 USA
| | - Chien-Ming Huang
- Urology Robotics Laboratory, School of Medicine, The Johns Hopkins University, Baltimore, MD 21224 USA
| | - Yihe Zuo
- Urology Robotics Laboratory, School of Medicine, The Johns Hopkins University, Baltimore, MD 21224 USA
| | - Doru Petrisor
- Urology Robotics Laboratory, School of Medicine, The Johns Hopkins University, Baltimore, MD 21224 USA
| | - Misop Han
- Urology Robotics Laboratory, School of Medicine, The Johns Hopkins University, Baltimore, MD 21224 USA
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Priester AM, Natarajan S, Culjat MO. Robotic ultrasound systems in medicine. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2013; 60:507-523. [PMID: 23475917 DOI: 10.1109/tuffc.2013.2593] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Robots ultrasound (RUS) can be defined as the combination of ultrasound imaging with a robotic system in medical interventions. With their potential for high precision, dexterity, and repeatability, robots are often uniquely suited for ultrasound integration. Although the field is relatively young, it has already generated a multitude of robotic systems for application in dozens of medical procedures. This paper reviews the robotic ultrasound systems that have been developed over the past two decades and describes their potential impact on modern medicine. The RUS projects reviewed include extracorporeal devices, needle guidance systems, and intraoperative systems.
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Affiliation(s)
- Alan M Priester
- Biomedical Engineering Interdepartmental Program and the Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, CA, USA.
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Hungr N, Baumann M, Long JA, Troccaz J. A 3-D Ultrasound Robotic Prostate Brachytherapy System With Prostate Motion Tracking. IEEE T ROBOT 2012. [DOI: 10.1109/tro.2012.2203051] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ho H, Yuen JSP, Mohan P, Lim EW, Cheng CWS. Robotic transperineal prostate biopsy: pilot clinical study. Urology 2011; 78:1203-8. [PMID: 21940041 DOI: 10.1016/j.urology.2011.07.1389] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 06/08/2011] [Accepted: 07/09/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develope a robot (BioXbot) that performs mapping transperineal prostate biopsy (PB) with two perineal skin punctures under ultrasound guidance. Our pilot study's clinical endpoints were complications and its technical endpoints were the duration for each phase. METHODS This institution review board-approved prospective clinical trial included patients with indications for PB. Two urologists performed these PBs. In the lithotomy position and under general anesthesia, the transrectal biplane ultrasound probe acquired transverse images of the prostate gland. The urologist defined its boundaries and planned the biopsy. It guided the PB in 3 axes, passing through a single perineal skin puncture for each prostate side. After each biopsy, it automatically moved to the next position. The steps were repeated on the contralateral side. RESULTS Our 20 patients had a mean prostate-specific antigen of 8.4 ± 4.9 ng/mL. Two patients had 2 previous biopsies, whereas the rest had one. The mean number of biopsies taken was 28.5 ± 6.2 in a mean total procedure time of 32.5 ± 3.2 minutes. We detected 3 patients with prostate cancer with Gleason score 3 + 3. Two patients required brief bladder catheterization after their biopsy. Their prostate volumes were >50 mL and the number of biopsies taken was >30 cores. There was no mechanical failure, sepsis, bleeding per-rectal, or perineal hematoma. CONCLUSION This pilot study demonstrated BioXbot's safety and feasibility as a biopsy platform. It can potentially be used for image-guided PB and focal therapy.
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Affiliation(s)
- H Ho
- Department of Urology, Singapore General Hospital, Singapore.
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Ho H, Yuen JSP, Cheng CWS. Robotic prostate biopsy and its relevance to focal therapy of prostate cancer. Nat Rev Urol 2011; 8:579-85. [PMID: 21931344 DOI: 10.1038/nrurol.2011.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Focal therapy is an individualized treatment option for prostate cancer, which destroys localized cancerous tissue but not normal tissue, thus avoiding the morbidities associated with whole-gland therapy. Accurate cancer localization and precise ablation are integral to the success of focal therapy, which remains unproven owing to suboptimal patient selection. Currently, there are no clinical or biopsy features that can identify unifocal prostate cancer and no imaging modality that can accurately diagnose or localize prostate cancer. MRI diagnosis has the best accuracy but high cost and limited access hinder its widespread adoption. New management options, including focal therapy and active surveillance, require prostate biopsy to detect, localize and characterize the cancer. Transrectal prostate biopsy has a high false-negative detection rate, which might be related to an inability to biopsy the anterior and apical part of the prostate or interoperator variation. Transrectal biopsy is also associated with sepsis and bleeding. Robotic transperineal prostate biopsy can overcome the limitations of transrectal procedures. Robotic biopsy is automated with high accuracy, has improved access to the apex and anterior part of the prostate and has low risk of sepsis. Furthermore, it involves only two skin punctures, compared with template-based transperineal prostate biopsy, which can result in multiple wounds. Robotic prostate biopsy fulfills the fundamental needs of focal therapy and might be the platform for future treatment delivery for prostate cancer.
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Affiliation(s)
- Henry Ho
- Singapore General Hospital, Urology, Outram Road, Singapore 609108, Singapore.
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Innovations in prostate biopsy strategies for active surveillance and focal therapy. Curr Opin Urol 2011; 21:115-20. [DOI: 10.1097/mou.0b013e3283435118] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Current world literature. Curr Opin Urol 2011; 21:166-72. [PMID: 21285721 DOI: 10.1097/mou.0b013e328344100a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kepner GR, Kepner JV. Transperineal prostate biopsy: analysis of a uniform core sampling pattern that yields data on tumor volume limits in negative biopsies. Theor Biol Med Model 2010; 7:23. [PMID: 20565775 PMCID: PMC2894753 DOI: 10.1186/1742-4682-7-23] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 06/17/2010] [Indexed: 11/12/2022] Open
Abstract
Background Analyze an approach to distributing transperineal prostate biopsy cores that yields data on the volume of a tumor that might be present when the biopsy is negative, and also increases detection efficiency. Methods Basic principles of sampling and probability theory are employed to analyze a transperineal biopsy pattern that uses evenly-spaced parallel cores in order to extract quantitative data on the volume of a small spherical tumor that could potentially be present, even though the biopsy did not detect it, i.e., negative biopsy. Results This approach to distributing biopsy cores provides data for the upper limit on the volume of a small, spherical tumor that might be present, and the probability of smaller volumes, when biopsies are negative and provides a quantitative basis for evaluating the effectiveness of different core spacing distances. Conclusions Distributing transperineal biopsy cores so they are evenly spaced provides a means to calculate the probability that a tumor of given volume could be present when the biopsy is negative, and can improve detection efficiency.
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