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Grisotto S, Cerrotta A, Pappalardi B, Carrara M, Messina A, Tenconi C, Valdagni R, Fallai C. Pre-implant magnetic resonance and transrectal ultrasound imaging in high-dose-rate prostate brachytherapy: comparison of prostate volumes, craniocaudal extents, and contours. J Contemp Brachytherapy 2018; 10:285-290. [PMID: 30237811 PMCID: PMC6142648 DOI: 10.5114/jcb.2018.77947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/17/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the prostate contours drawn by two radiation oncologists and one radiologist on magnetic resonance (MR) and transrectal ultrasound (TRUS) images. TRUS intra- and inter-fraction variability as well as TRUS vs. MR inter-modality and inter-operator variability were studied. MATERIAL AND METHODS Thirty patients affected by localized prostate cancer and treated with interstitial high-dose-rate (HDR) prostate brachytherapy at the National Cancer Institute in Milan were included in this study. Twenty-five patients received an exclusive two-fraction (14 Gy/fraction) treatment, while the other 5 received a single 14 Gy fraction as a boost after external beam radiotherapy. The prostate was contoured on TRUS images acquired before (virtual US) and after (real US) needle implant by two radiation oncologists, whereas on MR prostate was independently contoured by the same radiation oncologists (MR1, MR2) and by a dedicated radiologist (MR3). Absolute differences of prostate volumes (│ΔV│) and craniocaudal extents (│Δdz│) were evaluated. The Dice's coefficient (DC) was calculated to quantify spatial overlap between MR contours. RESULTS Significant difference was found between Vvirtual and Vlive (p < 0.001) for the first treatment fractions and between VMR1 and VMR2 (p = 0.043). Significant difference between cranio-caudal extents was found between dzvirtual and dzlive (p < 0.033) for the first treatment fractions, between dzvirtual of the first treatment fractions and dzMR1 (p < 0.001) and between dzMR1 and dzMR3 (p < 0.01). Oedema might be responsible for some of the changes in US volumes. Average DC values resulting from the comparison MR1 vs. MR2, MR1 vs. MR3 and MR2 vs. MR3 were 0.95 ± 0.04 (range, 0.82-0.99), 0.87 ± 0.04 (range, 0.73-0.91) and 0.87 ± 0.04 (range, 0.72-0.91), respectively. CONCLUSIONS Our results demonstrate the importance of a multiprofessional approach to TRUS-guided HDR prostate brachytherapy. Specific training in MR and US prostate imaging is recommended for centers that are unfamiliar with HDR prostate brachytherapy.
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Affiliation(s)
- Simone Grisotto
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Annamaria Cerrotta
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Brigida Pappalardi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Mauro Carrara
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Antonella Messina
- Diagnostic Imaging Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Chiara Tenconi
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Riccardo Valdagni
- Radiotherapy 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- Prostate Program, Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- Department of Medicine and Surgery, Universita’ degli Studi, Milan, Italy
| | - Carlo Fallai
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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Fontanarosa D, van der Meer S, Bamber J, Harris E, O'Shea T, Verhaegen F. Review of ultrasound image guidance in external beam radiotherapy: I. Treatment planning and inter-fraction motion management. Phys Med Biol 2015; 60:R77-114. [PMID: 25592664 DOI: 10.1088/0031-9155/60/3/r77] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In modern radiotherapy, verification of the treatment to ensure the target receives the prescribed dose and normal tissues are optimally spared has become essential. Several forms of image guidance are available for this purpose. The most commonly used forms of image guidance are based on kilovolt or megavolt x-ray imaging. Image guidance can also be performed with non-harmful ultrasound (US) waves. This increasingly used technique has the potential to offer both anatomical and functional information.This review presents an overview of the historical and current use of two-dimensional and three-dimensional US imaging for treatment verification in radiotherapy. The US technology and the implementation in the radiotherapy workflow are described. The use of US guidance in the treatment planning process is discussed. The role of US technology in inter-fraction motion monitoring and management is explained, and clinical studies of applications in areas such as the pelvis, abdomen and breast are reviewed. A companion review paper (O'Shea et al 2015 Phys. Med. Biol. submitted) will extensively discuss the use of US imaging for intra-fraction motion quantification and novel applications of US technology to RT.
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Affiliation(s)
- Davide Fontanarosa
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), Maastricht 6201 BN, the Netherlands. Oncology Solutions Department, Philips Research, High Tech Campus 34, Eindhoven 5656 AE, the Netherlands
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Impact of intraoperative MRI/TRUS fusion on dosimetric parameters in cT3a prostate cancer patients treated with high-dose-rate real-time brachytherapy. J Contemp Brachytherapy 2014; 6:154-60. [PMID: 25097555 PMCID: PMC4105645 DOI: 10.5114/jcb.2014.43299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/06/2014] [Accepted: 06/26/2014] [Indexed: 12/19/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of intraoperative MRI/TRUS fusion procedure in cT3a prostate cancer patients treated with high-dose-rate (HDR) real-time brachytherapy. Material and methods Prostate gland, dominant intraprostatic lesions (DILs), and extracapsular extension (ECE) were delineated in the pre-brachytherapy magnetic resonance images (MRI) of 9 consecutive patients. The pre-implant P-CTVUS (prostate clinical target volume) was defined as the prostate seen in the transrectal ultrasound (TRUS) images. The CTVMR includedthe prostate with the ECE image (ECE-CTV) as defined on the MRI. Two virtual treatment plans were performed based on the MRI/TRUS fusion images, the first one prescribing 100% of the dose to the P-PTVUS, and the second prescribing to the PTVMR. The implant parameters and dose-volume histogram (DVH) related parameters of the prostate, OARs, and ECE were compared between both plans. Results Mean radial distance of ECE was 3.6 mm (SD: 1.1). No significant differences were found between prostate V100, V150, V200, and OARs DVH-related parameters between the plans. Mean values of ECE V100, V150, and V200 were 85.9% (SD: 15.1), 18.2% (SD: 17.3), and 5.85% (SD: 7) when the doses were prescribed to the PTVUS, whereas ECE V100, V150, and V200 were 99.3% (SD: 1.2), 45.8% (SD: 22.4), and 19.6% (SD: 12.6) when doses were prescribed to PTVMR (p = 0.028, p = 0.002 and p = 0.004, respectively). Conclusions TRUS/MRI fusion provides important information for prostate brachytherapy, allowing for better coverage and higher doses to extracapsular disease in patients with clinical stage T3a.
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Fedorov A, Song SE, Kapur T, Owen R, Sugar EN, Nguyen P, Wells WM, Tempany CM. Prototype Design and Phantom Evaluation of a Device for Co-registered MRI/TRUS Imaging of the Prostate. CLINICAL IMAGE-BASED PROCEDURES : FROM PLANNING TO INTERVENTION : INTERNATIONAL WORKSHOP, CLIP ..., HELD IN CONJUNCTION WITH MICCAI ... : REVISED SELECTED PAPERS. CLIP (WORKSHOP) 2014; 8361:125-133. [PMID: 25364786 PMCID: PMC4211424 DOI: 10.1007/978-3-319-05666-1_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Magnetic Resonance Imaging (MRI) and transrectal Ultrasound (TRUS) are both used in imaging interventions in men suspected of having and with prostate cancer for diagnosis as well as treatment. Due to the widespread availability and ease of use of TRUS, it is widely acknowledged that availability of spatially registered MRI/TRUS data could provide the optimal combination for characterization of prostate tissue and interventional guidance. To provide such spatially aligned data, we propose a device to support co-registered acquisition of MRI and TRUS data while maintaining a stable configuration (shape) of the prostate. We present the design and evaluation of a custom sleeve that can be introduced transrectally, and can accommodate both TRUS and endorectal MRI probes. Our experiments on a phantom have demonstrated that imaging with this sleeve did not compromise differentiation of internal structures and did not affect the quality of the MR acquisition. Reduction of the signal and contrast were however observed and quantified in the TRUS data. Further evaluation and modification of the device necessary for possible patient studies are discussed.
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Affiliation(s)
- Andriy Fedorov
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sang-Eun Song
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tina Kapur
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Emily Neubauer Sugar
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Paul Nguyen
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - William M. Wells
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Clare M. Tempany
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Moradi M, Janoos F, Fedorov A, Risholm P, Kapur T, Wolfsberger LD, Nguyen PL, Tempany CM, Wells WM. Two solutions for registration of ultrasound to MRI for image-guided prostate interventions. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:1129-32. [PMID: 23366095 DOI: 10.1109/embc.2012.6346134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ultrasound-guided prostate interventions could benefit from incorporating the radiologic localization of the tumor which can be acquired from multiparametric MRI. To enable this integration, we propose and compare two solutions for registration of T2 weighted MR images with transrectal ultrasound. Firstly, we propose an innovative and practical approach based on deformable registration of binary label maps obtained from manual segmentation of the gland in the two modalities. This resulted in a target registration error of 3.6±1.7 mm. Secondly, we report a novel surface-based registration method that uses a biomechanical model of the tissue and results in registration error of 3.2±1.3 mm. We compare the two methods in terms of accuracy, clinical use and technical limitations.
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Affiliation(s)
- Mehdi Moradi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada.
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Mari JM, Bouchoux G, Dillenseger JL, Gimonet S, Birer A, Garnier C, Brasset L, Ke W, Guey JL, Fleury G, Chapelon JY, Blanc E. Study of a dual-mode array integrated in a multi-element transducer for imaging and therapy of prostate cancer. Ing Rech Biomed 2013. [DOI: 10.1016/j.irbm.2013.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sparks R, Bloch BN, Feleppa E, Barratt D, Madabhushi A. Fully Automated Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Fusion via a Probabilistic Registration Metric. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2013; 8671. [PMID: 24353393 DOI: 10.1117/12.2007610] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In this work, we present a novel, automated, registration method to fuse magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) images of the prostate. Our methodology consists of: (1) delineating the prostate on MRI, (2) building a probabilistic model of prostate location on TRUS, and (3) aligning the MRI prostate segmentation to the TRUS probabilistic model. TRUS-guided needle biopsy is the current gold standard for prostate cancer (CaP) diagnosis. Up to 40% of CaP lesions appear isoechoic on TRUS, hence TRUS-guided biopsy cannot reliably target CaP lesions and is associated with a high false negative rate. MRI is better able to distinguish CaP from benign prostatic tissue, but requires special equipment and training. MRI-TRUS fusion, whereby MRI is acquired pre-operatively and aligned to TRUS during the biopsy procedure, allows for information from both modalities to be used to help guide the biopsy. The use of MRI and TRUS in combination to guide biopsy at least doubles the yield of positive biopsies. Previous work on MRI-TRUS fusion has involved aligning manually determined fiducials or prostate surfaces to achieve image registration. The accuracy of these methods is dependent on the reader's ability to determine fiducials or prostate surfaces with minimal error, which is a difficult and time-consuming task. Our novel, fully automated MRI-TRUS fusion method represents a significant advance over the current state-of-the-art because it does not require manual intervention after TRUS acquisition. All necessary preprocessing steps (i.e. delineation of the prostate on MRI) can be performed offline prior to the biopsy procedure. We evaluated our method on seven patient studies, with B-mode TRUS and a 1.5 T surface coil MRI. Our method has a root mean square error (RMSE) for expertly selected fiducials (consisting of the urethra, calcifications, and the centroids of CaP nodules) of 3.39 ± 0.85 mm.
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Affiliation(s)
- Rachel Sparks
- Department of Biomedical Engineering, Rutgers University ; Department of Biomedical Engineering, Case Western Reserve University
| | - B Nicolas Bloch
- Department of Radiology, Boston Medical Center & Boston University
| | - Ernest Feleppa
- Lizzi Center for Biomedical Engineering, Riverside Research
| | - Dean Barratt
- Centre for Medical Image Computing, University College London
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University
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Magnetic resonance imaging-based treatment planning for prostate brachytherapy. Brachytherapy 2013; 12:30-7. [PMID: 22727474 DOI: 10.1016/j.brachy.2012.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/17/2012] [Accepted: 03/30/2012] [Indexed: 02/03/2023]
Abstract
PURPOSE Transrectal ultrasound (TRUS) is the standard imaging modality for planning prostate brachytherapy. However, magnetic resonance imaging (MRI) provides greater anatomic detail than TRUS. We compared treatment plans generated using TRUS, endorectal coil MRI (erMRI), and standard body array coil MRI (sMRI). METHODS AND MATERIALS Treatment plans were used from patients treated with permanent, stranded-seed (125)I brachytherapy in a prospective trial. All men underwent pretreatment planning based on TRUS, and all underwent erMRI before treatment and sMRI 30 days after the implant. Treatments for 20 consecutive patients were replanned on sMRI and erMRI images by investigators blinded to TRUS-based plans. Prostate volume/dimensions, radioactivity-to-prostate-volume ratio, and dosimetric parameters were compared. RESULTS Compared with TRUS, mean prostate volume measured by erMRI was smaller, medial-lateral diameter was larger, and anterior-posterior diameter was smaller, suggesting that the endorectal coil produced anatomic distortions. Craniocaudal prostate length was smaller on both types of MRI than on TRUS, suggesting that TRUS overestimates prostate length. Activity per volume was 7.5% lower for plans based on sMRI than on TRUS (0.901 vs. 0.974mCi/cm(3), p<0.001). sMRI plans had similar coverage of the planning target volume (PTV) (dose to 90% of the prostate [D(90)] 116.6% sMRI vs. 117.5% TRUS, p=0.526) and improved dose homogeneity (percentage of PTV receiving 150% of the prescription dose [V(150)] 47.4% sMRI vs. 53.8% TRUS, p=0.001 and percentage of PTV receiving 200% of the prescription dose [V(200)] 16.6% sMRI vs. 19.2% TRUS, p<0.001). CONCLUSIONS Staging erMRI should not be routinely used for treatment planning because it produces anatomic distortion. sMRI may have treatment planning advantages over TRUS because of superior soft-tissue delineation of the prostate and adjacent normal tissue structures.
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Mahdavi SS, Spadinger I, Chng N, Salcudean SE, Morris WJ. Semiautomatic segmentation for prostate brachytherapy: Dosimetric evaluation. Brachytherapy 2013; 12:65-76. [DOI: 10.1016/j.brachy.2011.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 07/05/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
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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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Long JA, Hungr N, Baumann M, Descotes JL, Bolla M, Giraud JY, Rambeaud JJ, Troccaz J. Development of a novel robot for transperineal needle based interventions: focal therapy, brachytherapy and prostate biopsies. J Urol 2012; 188:1369-74. [PMID: 22906671 DOI: 10.1016/j.juro.2012.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Indexed: 01/25/2023]
Abstract
PURPOSE We report what is to our knowledge the initial experience with a new 3-dimensional ultrasound robotic system for prostate brachytherapy assistance, focal therapy and prostate biopsies. Its ability to track prostate motion intraoperatively allows it to manage motions and guide needles to predefined targets. MATERIALS AND METHODS A robotic system was created for transrectal ultrasound guided needle implantation combined with intraoperative prostate tracking. Experiments were done on 90 targets embedded in a total of 9 mobile, deformable, synthetic prostate phantoms. Experiments involved trying to insert glass beads as close as possible to targets in multimodal anthropomorphic imaging phantoms. Results were measured by segmenting the inserted beads in computerized tomography volumes of the phantoms. RESULTS The robot reached the chosen targets in phantoms with a median accuracy of 2.73 mm and a median prostate motion of 5.46 mm. Accuracy was better at the apex than at the base (2.28 vs 3.83 mm, p <0.001), and similar for horizontal and angled needle inclinations (2.7 vs 2.82 mm, p = 0.18). CONCLUSIONS To our knowledge this robot for prostate focal therapy, brachytherapy and targeted prostate biopsies is the first system to use intraoperative prostate motion tracking to guide needles into the prostate. Preliminary experiments show its ability to reach targets despite prostate motion.
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A spline-based non-linear diffeomorphism for multimodal prostate registration. Med Image Anal 2012; 16:1259-79. [PMID: 22705289 DOI: 10.1016/j.media.2012.04.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 04/24/2012] [Accepted: 04/25/2012] [Indexed: 11/24/2022]
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Sara Mahdavi S, Moradi M, Wen X, Morris WJ, Salcudean SE. Evaluation of visualization of the prostate gland in vibro-elastography images. Med Image Anal 2011; 15:589-600. [DOI: 10.1016/j.media.2011.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/01/2011] [Accepted: 03/15/2011] [Indexed: 01/15/2023]
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Baumann M, Bolla M, Daanen V, Descotes JL, Giraud JY, Hungr N, Leroy A, Long JA, Martin S, Troccaz J. Prosper: Image and robot-guided prostate brachytherapy. Ing Rech Biomed 2011. [DOI: 10.1016/j.irbm.2011.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ukimura O, Hirahara N, Fujihara A, Yamada T, Iwata T, Kamoi K, Okihara K, Ito H, Nishimura T, Miki T. Technique for a hybrid system of real-time transrectal ultrasound with preoperative magnetic resonance imaging in the guidance of targeted prostate biopsy. Int J Urol 2010; 17:890-3. [PMID: 20812938 DOI: 10.1111/j.1442-2042.2010.02617.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diagnostic magnetic resonance imaging (MRI) for prostate has achieved increasingly higher levels of accuracy. Because real-time MR-guided targeted biopsy is still a complicated and expensive procedure, there is considerable interest in a technique of MR/transrectal ultrasound (TRUS) hybridized image-guided biopsy. However, because the 3-D shapes of the prostate at the time of image-acquisition at preoperative MRI are likely to be different from the intra-operative TRUS images, the precise registration of each 3-D volume data is critical. To reduce the potential errors in registration of TRUS with MRI, we introduce new procedural techniques in a rigid image fusion technique. First, preoperative MR images were obtained with a specifically-made plastic outer-frame, with exactly the same shape as the real TRUS probe, placed in the rectum, in order to simulate the deformation of the prostate caused by the absence or presence of a TRUS probe during the acquisition of MR or TRUS images. Second, instead of using a single plane of longitudinal image, we applied biplane TRUS images to be shown in parallel on a multiplanar display with corresponding reconstructed MRI, in order to register both horizontal and longitudinal images of the prostate simultaneously, thereby achieving improved 3-D anatomical matching.
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Affiliation(s)
- Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto, Japan.
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Miyagawa T, Ishikawa S, Kimura T, Suetomi T, Tsutsumi M, Irie T, Kondoh M, Mitake T. Real-time Virtual Sonography for navigation during targeted prostate biopsy using magnetic resonance imaging data. Int J Urol 2010; 17:855-60. [PMID: 20807266 DOI: 10.1111/j.1442-2042.2010.02612.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of the medical navigation technique, namely, Real-time Virtual Sonography (RVS), for targeted prostate biopsy. METHODS Eighty-five patients with suspected prostate cancer lesions using magnetic resonance imaging (MRI) were included in this study. All selected patients had at least one negative result on the previous transrectal biopsies. The acquired MRI volume data were loaded onto a personal computer installed with RVS software, which registers the volumes between MRI and real-time ultrasound data for real-time display. The registered MRI images were displayed adjacent to the ultrasonographic sagittal image on the same computer monitor. The suspected lesions on T2-weighted images were marked with a red circle. At first suspected lesions were biopsied transperineally under real-time navigation with RVS and then followed by the conventional transrectal and transperineal biopsy under spinal anesthesia. RESULTS The median age of the patients was 69 years (56-84 years), and the prostate-specific antigen level and prostate volume were 9.9 ng/mL (4.0-34.2) and 37.2 mL (18-141), respectively. Prostate cancer was detected in 52 patients (61%). The biopsy specimens obtained using RVS revealed 45/52 patients (87%) positive for prostate cancer. A total of 192 biopsy cores were obtained using RVS. Sixty-two of these (32%) were positive for prostate cancer, whereas conventional random biopsy revealed cancer only in 75/833 (9%) cores (P < 0.01). CONCLUSIONS Targeted prostate biopsy with RVS is very effective to diagnose lesions detected with MRI. This technique only requires additional computer and RVS software and thus is cost-effective. Therefore, RVS-guided prostate biopsy has great potential for better management of prostate cancer patients.
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Affiliation(s)
- Tomoaki Miyagawa
- Department of Urology, Hitachi General Hospital, Hitachi, Ibaraki, Japan.
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Ho HSS, Mohan P, Lim ED, Li DL, Yuen JSP, Ng WS, Lau WKO, Cheng CWS. Robotic ultrasound-guided prostate intervention device: system description and results from phantom studies. Int J Med Robot 2009; 5:51-8. [PMID: 19145573 DOI: 10.1002/rcs.232] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We introduce the first robotic ultrasound-guided prostate intervention device and evaluate its safety, accuracy and repeatability. METHODS The robotic positioning system (RPS) determines a target's x, y and z axes. It is situated with a biplane ultrasound probe on a mobile horizontal platform. The integrated software acquires ultrasound images for three-dimensional (3D) modelling, coordinates target planning and directs the RPS. RESULTS The egg phantom evaluates the software's safety and workflow protocol. Two random targets are planned in each quadrant and biopsy needles are inserted. All were within three separate eggs. Metal wire tips are targeted and their distances from the biopsy needle tips are measured. With 20 wires, < 1 mm accuracy is obtained. Repeatability is demonstrated when previous positions are returned to with similar accuracy. CONCLUSION Our device demonstrates safety in a defined boundary with a repeatable accuracy of < 1 mm. It can be used for accurate prostate biopsy and treatment delivery.
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Affiliation(s)
- H S S Ho
- Department of Urology, Singapore General Hospital, Singapore.
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Misra S, Macura KJ, Ramesh KT, Okamura AM. The importance of organ geometry and boundary constraints for planning of medical interventions. Med Eng Phys 2008; 31:195-206. [PMID: 18815068 DOI: 10.1016/j.medengphy.2008.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 07/01/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
Abstract
Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development of high-fidelity simulators and planners. Organ geometry, soft-tissue constitutive laws, and boundary conditions imposed by the connective tissues surrounding the organ are some of the factors that govern the accuracy of medical intervention planning. In this study it is demonstrated that, for needle path planning, the organ geometry and boundary constraints surrounding the organ are the most important factors influencing the deformation. As an example, the procedure of needle insertion into the prostate (e.g. for biopsy or brachytherapy) is considered. Image segmentation is used to extract the anatomical details from magnetic resonance images, while object-oriented finite element analysis (OOF) software is used to generate finite element (FE) meshes from the segmented images. Two-dimensional FE simulations that account for complex anatomical details along with relative motion between the prostate and its surrounding structure using cohesive zone models are compared with traditional simulation models having simple organ geometry and boundary constraints. Nodal displacements for these simpler models were observed to be up to 14 times larger than those obtained from the anatomically accurate models.
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Affiliation(s)
- S Misra
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA.
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Abstract
In this article the current issues of diagnosis and detection of prostate cancer are reviewed. The limitations for current techniques are highlighted and some possible solutions with MR imaging and MR-guided biopsy approaches are reviewed. There are several different biopsy approaches under investigation. These include transperineal open magnet approaches to closed-bore 1.5T transrectal biopsies. The imaging, image processing, and tracking methods are also discussed. In the arena of therapy, MR guidance has been used in conjunction with radiation methods, either brachytherapy or external delivery. The principles of the radiation treatment, the toxicities, and use of images are outlined. The future role of imaging and image-guided interventions lie with providing a noninvasive surrogate for cancer surveillance or monitoring treatment response. The shift to minimally invasive focal therapies has already begun and will be very exciting when MR-guided focused ultrasound surgery reaches its full potential.
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Affiliation(s)
- Clare Tempany
- Department of Radiology, Brigham & Women's Hospital, Boston, MA 02115, USA.
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HDR prostate monotherapy – Dosimetric effects of implant deformation due to posture change between TRUS- and CT-imaging. Radiother Oncol 2008; 86:114-9. [DOI: 10.1016/j.radonc.2007.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 10/29/2007] [Accepted: 11/02/2007] [Indexed: 11/21/2022]
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