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Yang L, Duan S, Zhang Y, Hao L, Wang S, Zou Z, Hu Y, Chen S, Hu Y, Zhang L. Feasibility and Safety of Percutaneous Puncture Guided by a 5G-Based Telerobotic Ultrasound System: An Experimental Study. Cardiovasc Intervent Radiol 2024; 47:812-819. [PMID: 38592415 DOI: 10.1007/s00270-024-03681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/31/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To evaluate the feasibility and safety of percutaneous puncture guided by a 5th generation mobile communication technology (5G)-based telerobotic ultrasound system in phantom and animal experiments. MATERIALS AND METHODS In the phantom experiment, 10 simulated lesions were punctured, once at each of two angles for each lesion, under the guidance of a telerobotic ultrasound system and ultrasound-guided freehand puncture. Student's t test was used to compare the two methods in terms of puncture accuracy, total operation duration, and puncture duration. In the animal experiment, under the guidance of the telerobotic ultrasound system, an 18G puncture needle was used to puncture 3 target steel beads in the liver, right kidney, and right gluteal muscle, respectively. The animal experiment had no freehand ultrasound-guided control group. After puncture, a CT scan was performed to verify the position of the puncture needle in relation to the target, and the complications and puncture duration, etc., were recorded. RESULTS In the phantom experiment, the mean accuracies of puncture under telerobotic ultrasound guidance and conventional ultrasound guidance were 1.8 ± 0.3 mm and 1.6 ± 0.3 mm (P = 0.09), respectively; therefore, there was no significant difference in the accuracy of the two guide methods. In the animal experiment, the first-attempt puncture success (the needle tip close to the target) rate was 93%. Polypnea occurred during one puncture. No other intraoperative or postoperative complications were observed. CONCLUSION Puncture guided by a 5G-based telerobotic ultrasound system has shown good feasibility and safety in phantom and animal experiments.
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Affiliation(s)
- Lanling Yang
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Shaobo Duan
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
- Department of Ultrasound, Henan Key Laboratory for Ultrasound Molecular Imaging and Artificial Intelligence Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, No.7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Ye Zhang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Liuwei Hao
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Shuaiyang Wang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Zhi Zou
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Yanshan Hu
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Si Chen
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Yiwen Hu
- Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
| | - Lianzhong Zhang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China.
- Department of Rehabilitation, Henan Rehabilitation Clinical Medicine Research Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China.
- Department of Ultrasound, Henan Key Laboratory for Ultrasound Molecular Imaging and Artificial Intelligence Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, No.7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.
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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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Bernardes MC, Moreira P, Mareschal L, Tempany C, Tuncali K, Hata N, Tokuda J. Data-driven adaptive needle insertion assist for transperineal prostate interventions. Phys Med Biol 2023; 68:10.1088/1361-6560/accefa. [PMID: 37080237 PMCID: PMC10249778 DOI: 10.1088/1361-6560/accefa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/20/2023] [Indexed: 04/22/2023]
Abstract
Objective.Clinical outcomes of transperineal prostate interventions, such as biopsy, thermal ablations, and brachytherapy, depend on accurate needle placement for effectiveness. However, the accurate placement of a long needle, typically 150-200 mm in length, is challenging due to needle deviation induced by needle-tissue interaction. While several approaches for needle trajectory correction have been studied, many of them do not translate well to practical applications due to the use of specialized needles not yet approved for clinical use, or to relying on needle-tissue models that need to be tailored to individual patients.Approach.In this paper, we present a robot-assisted collaborative needle insertion method that only requires an actuated passive needle guide and a conventional needle. The method is designed to assist a physician inserting a needle manually through a needle guide. If the needle is deviated from the intended path, actuators shifts the needle radially in order to steer the needle trajectory and compensate for needle deviation adaptively. The needle guide is controlled by a new data-driven algorithm which does not requirea prioriinformation about needle or tissue properties. The method was evaluated in experiments with bothin vitroandex vivophantoms.Main results.The experiments inex vivotissue reported a mean final placement error of 0.36 mm with a reduction of 96.25% of placement error when compared to insertions without the use of assistive correction.Significance.Presented results show that the proposed closed-loop formulation can be successfully used to correct needle deflection during collaborative manual insertion with potential to be easily translated into clinical application.
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Affiliation(s)
- Mariana C Bernardes
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Pedro Moreira
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lisa Mareschal
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
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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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Liang H, Tse ZTH. MR conditional prostate intervention systems and actuations review. Proc Inst Mech Eng H 2023; 237:18-34. [PMID: 36458323 PMCID: PMC9841823 DOI: 10.1177/09544119221136169] [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] [Indexed: 12/04/2022]
Abstract
Magnetic resonance imaging (MRI) has the ability to provide high-resolution images of soft tissues without the use of radiation. So much research has been focused on the development of actuators and robotic devices that can be used in the MRI environment so "real-time" images can be obtained during surgeries. With real-time guidance from MRI, robots can perform surgical procedures with high accuracy and through less invasive routes. This technique can also significantly reduce the operation time and simplify pre-surgical procedures. Therefore, research on robot-assisted MRI-guided prostate intervention has attracted a great deal of interest, and several successful clinical trials have been published in recent years, pointing to the great potential of this technology. However, the development of MRI-guided robots is still in the primary stage, and collaboration between researchers and commercial suppliers is still needed to improve such robot systems. This review presents an overview of MRI-guided prostate intervention devices and actuators. Additionally, the expected technical challenges and future advances in this field are discussed.
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Affiliation(s)
| | - Zion Tsz Ho Tse
- Zion Tsz Ho Tse, School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK.
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6
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Su H, Kwok KW, Cleary K, Iordachita I, Cavusoglu MC, Desai JP, Fischer GS. State of the Art and Future Opportunities in MRI-Guided Robot-Assisted Surgery and Interventions. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:968-992. [PMID: 35756185 PMCID: PMC9231642 DOI: 10.1109/jproc.2022.3169146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Magnetic resonance imaging (MRI) can provide high-quality 3-D visualization of target anatomy, surrounding tissue, and instrumentation, but there are significant challenges in harnessing it for effectively guiding interventional procedures. Challenges include the strong static magnetic field, rapidly switching magnetic field gradients, high-power radio frequency pulses, sensitivity to electrical noise, and constrained space to operate within the bore of the scanner. MRI has a number of advantages over other medical imaging modalities, including no ionizing radiation, excellent soft-tissue contrast that allows for visualization of tumors and other features that are not readily visible by other modalities, true 3-D imaging capabilities, including the ability to image arbitrary scan plane geometry or perform volumetric imaging, and capability for multimodality sensing, including diffusion, dynamic contrast, blood flow, blood oxygenation, temperature, and tracking of biomarkers. The use of robotic assistants within the MRI bore, alongside the patient during imaging, enables intraoperative MR imaging (iMRI) to guide a surgical intervention in a closed-loop fashion that can include tracking of tissue deformation and target motion, localization of instrumentation, and monitoring of therapy delivery. With the ever-expanding clinical use of MRI, MRI-compatible robotic systems have been heralded as a new approach to assist interventional procedures to allow physicians to treat patients more accurately and effectively. Deploying robotic systems inside the bore synergizes the visual capability of MRI and the manipulation capability of robotic assistance, resulting in a closed-loop surgery architecture. This article details the challenges and history of robotic systems intended to operate in an MRI environment and outlines promising clinical applications and associated state-of-the-art MRI-compatible robotic systems and technology for making this possible.
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Affiliation(s)
- Hao Su
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695 USA
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
| | - Kevin Cleary
- Children's National Health System, Washington, DC 20010 USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21218 USA
| | - M Cenk Cavusoglu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Jaydev P Desai
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Gregory S Fischer
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 USA
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7
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Prostate Cancer Detection Rate of Manually Operated and Robot-assisted In-bore Magnetic Resonance Imaging Targeted Biopsy. EUR UROL SUPPL 2022; 41:88-94. [PMID: 35813252 PMCID: PMC9257664 DOI: 10.1016/j.euros.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background The diagnostic efficacy regarding prostate cancer (PC) detection by manually operated in-bore magnetic resonance imaging (MRI) targeted prostate biopsy (MO-MRGB) versus robot-assisted in-bore MRI targeted prostate biopsy (RA-MRGB) is lacking evidence. Objective We hypothesized that the detection rates (DRs) for PC of MO-MRGB and RA-MRGB were similar and aimed to compare these. Design, setting, and participants We prospectively included all patients who received in-bore MRI targeted prostate biopsy (MRGB) of the prostate in the Central Denmark Region from August 2014 to February 2020. From August 2014, MO-MRGB was used, and from March 2018, RA-MRGB was preferred. Referral to in-bore MRGB was based on multiparametric MRI (mpMRI). Outcome measurements and statistical analysis We compared PC DRs of MO-MRGB and RA-MRGB with Pearson’s chi-square test. We made three binary regression models and calculated the risk difference (RD) of PC between the in-bore MRGB systems. Results and limitations A total of 3107 patients were referred to mpMRI, and 884 (28%) patients went on to receive in-bore MRGB. The MO-MRGB and RA-MRGB systems were used in 505 (57%) and 379 (43%) patients, respectively. Taking clinically relevant covariates into account, we found no statistically significant difference in PC DRs between MO-MRGB and RA-MRGB (72% vs 73%, RD 1%, 95% confidence interval –4% to 7%, p = 0.6). The main limitation was a shift in population characteristics. Conclusions We did not see evidence of an effect on the DR or the RD for PC when we compared MO-MRGB with RA-MRGB. Cost effectiveness should be considered carefully when choosing the MRGB system. Patient summary We compared two magnetic resonance imaging guided prostate tissue sampling systems regarding prostate cancer (PC) detection. One system was manually operated, and the other system was robot assisted. Comparing the systems, we found no evidence of a difference in their ability to detect PC.
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Mahcicek DI, Yildirim KD, Kasaci G, Kocaturk O. Preliminary Evaluation of Hydraulic Needle Delivery System for Magnetic Resonance Imaging-Guided Prostate Biopsy Procedures. J Med Device 2021. [DOI: 10.1115/1.4051610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
In clinical routine, the prostate biopsy procedure is performed with the guidance of transrectal ultrasound (TRUS) imaging to diagnose prostate cancer. However, the TRUS-guided prostate biopsy brings reliability concerns due to the lack of contrast difference between prostate tissue and lesions. In this study, a novel hydraulic needle delivery system that is designed for performing magnetic resonance imaging (MRI)-guided prostate biopsy procedure with transperineal approach is introduced. The feasibility of the overall system was evaluated through in vitro phantom experiments under an MRI guidance. The in vitro experiments performed using a certified prostate phantom (incorporating MRI visible lesions). MRI experiments showed that overall hydraulic biopsy needle delivery system has excellent MRI compatibility (signal to noise ratio (SNR) loss < 3%), provides acceptable targeting accuracy (average 2.05±0.46 mm) and procedure time (average 40 min).
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Affiliation(s)
- Davut Ibrahim Mahcicek
- Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Korel D. Yildirim
- National Institutes of Health Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD 20892-1538; Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Gokce Kasaci
- Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
| | - Ozgur Kocaturk
- National Institutes of Health Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD 20892-1538; Biomedical Engineering Department, Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Cengelkoy 34684, Turkey
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9
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Wang L, Zhang Y, Zuo S, Xu Y. A review of the research progress of interventional medical equipment and methods for prostate cancer. Int J Med Robot 2021; 17:e2303. [PMID: 34231317 DOI: 10.1002/rcs.2303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prostate cancer is a common disease in men and has a relatively high mortality rate. However, the interventional medical equipment used for prostate biopsy and brachytherapy has always been a social concern. METHODS To understand interventional medical equipment for prostate cancer, the structure of manual, semi-automatic and automatic medical equipment were considered as the mainline, while the corresponding research on these structures were the auxiliary lines. The characteristics and corresponding research status have been discussed. RESULTS Interventional medical equipment for prostate cancer with different degrees of automation and its characteristics were determined, and the imaging principles and characteristics of computed tomography, transrectal ultrasound and magnetic resonance imaging have been briefly described. CONCLUSION Certain feasible research suggestions have been proposed for future development from the perspective of structure, accuracy and safety. These include flexible and compact robot structures, high-precision image recognition and guidance, accurate dose planning and monitoring, real-time imaging monitoring without delay, high-precision needle insertion strategy, master-slave control, virtual reality and remote control.
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Affiliation(s)
- Lifeng Wang
- Intelligent Machine Institute, Harbin University of Science and Technology, Harbin, China
| | - Yongde Zhang
- Intelligent Machine Institute, Harbin University of Science and Technology, Harbin, China
| | - Sihao Zuo
- Intelligent Machine Institute, Harbin University of Science and Technology, Harbin, China.,Foshan Baikang Robot Technology Co., Ltd., Foshan, China
| | - Yong Xu
- Chinese PLA General Hospital, Beijing, China
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10
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Velazco-Garcia JD, Navkar NV, Balakrishnan S, Younes G, Abi-Nahed J, Al-Rumaihi K, Darweesh A, Elakkad MSM, Al-Ansari A, Christoforou EG, Karkoub M, Leiss EL, Tsiamyrtzis P, Tsekos NV. Evaluation of how users interface with holographic augmented reality surgical scenes: Interactive planning MR-Guided prostate biopsies. Int J Med Robot 2021; 17:e2290. [PMID: 34060214 DOI: 10.1002/rcs.2290] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/04/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND User interfaces play a vital role in the planning and execution of an interventional procedure. The objective of this study is to investigate the effect of using different user interfaces for planning transrectal robot-assisted MR-guided prostate biopsy (MRgPBx) in an augmented reality (AR) environment. METHOD End-user studies were conducted by simulating an MRgPBx system with end- and side-firing modes. The information from the system to the operator was rendered on HoloLens as an output interface. Joystick, mouse/keyboard, and holographic menus were used as input interfaces to the system. RESULTS The studies indicated that using a joystick improved the interactive capacity and enabled operator to plan MRgPBx in less time. It efficiently captures the operator's commands to manipulate the augmented environment representing the state of MRgPBx system. CONCLUSIONS The study demonstrates an alternative to conventional input interfaces to interact and manipulate an AR environment within the context of MRgPBx planning.
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Affiliation(s)
| | - Nikhil V Navkar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Georges Younes
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Adham Darweesh
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Mansour Karkoub
- Department of Mechanical Engineering, Texas A&M University-Qatar, Doha, Qatar
| | - Ernst L Leiss
- Department of Computer Science, University of Houston, Houston, Texas, USA
| | | | - Nikolaos V Tsekos
- Department of Computer Science, University of Houston, Houston, Texas, USA
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11
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Velazco‐Garcia JD, Navkar NV, Balakrishnan S, Abi‐Nahed J, Al‐Rumaihi K, Darweesh A, Al‐Ansari A, Christoforou EG, Karkoub M, Leiss EL, Tsiamyrtzis P, Tsekos NV. End‐user evaluation of software‐generated intervention planning environment for transrectal magnetic resonance‐guided prostate biopsies. Int J Med Robot 2020; 17:1-12. [DOI: 10.1002/rcs.2179] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | | | | | | | | | - Adham Darweesh
- Department of Clinical Imaging Hamad Medical Corporation Doha Qatar
| | | | | | - Mansour Karkoub
- Department of Mechanical Engineering Texas A&M University—Qatar Doha Qatar
| | - Ernst L. Leiss
- Department of Computer Science University of Houston Houston Texas USA
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12
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Patel NA, Nycz CJ, Carvalho PA, Gandomi KY, Gondokaryono R, Li G, Heffter T, Burdette EC, Pilitsis JG, Fischer GS. An Integrated Robotic System for MRI-Guided Neuroablation: Preclinical Evaluation. IEEE Trans Biomed Eng 2020; 67:2990-2999. [PMID: 32078530 PMCID: PMC7529397 DOI: 10.1109/tbme.2020.2974583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Treatment of brain tumors requires high precision in order to ensure sufficient treatment while minimizing damage to surrounding healthy tissue. Ablation of such tumors using needle-based therapeutic ultrasound (NBTU) under real-time magnetic resonance imaging (MRI) can fulfill this need. However, the constrained space and strong magnetic field in the MRI bore restricts patient access limiting precise placement of the NBTU ablation tool. A surgical robot compatible with use inside the bore of an MRI scanner can alleviate these challenges. METHODS We present preclinical trials of a robotic system for NBTU ablation of brain tumors under real-time MRI guidance. The system comprises of an updated robotic manipulator and corresponding control electronics, the NBTU ablation system and applications for planning, navigation and monitoring of the system. RESULTS The robotic system had a mean translational and rotational accuracy of 1.39 ± 0.64 mm and 1.27 [Formula: see text] in gelatin phantoms and 3.13 ± 1.41 mm and 5.58 [Formula: see text] in 10 porcine trials while causing a maximum reduction in signal to noise ratio (SNR) of 10.3%. CONCLUSION The integrated robotic system can place NBTU ablator at a desired target location in porcine brain and monitor the ablation in realtime via magnetic resonance thermal imaging (MRTI). SIGNIFICANCE Further optimization of this system could result in a clinically viable system for use in human trials for various diagnostic or therapeutic neurosurgical interventions.
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13
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Carvalho PAWG, Nycz CJ, Gandomi KY, Fischer GS. Demonstration and Experimental Validation of Plastic-Encased Resonant Ultrasonic Piezoelectric Actuator for Magnetic Resonance Imaging-Guided Surgical Robots. JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY 2020; 3:011002. [PMID: 32704623 PMCID: PMC7376759 DOI: 10.1115/1.4044609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Intra-operative medical imaging based on magnetic resonance imaging (MRI) coupled with robotic manipulation of surgical instruments enables precise feedback-driven procedures. Electrically powered nonferromagnetic motors based on piezoelectric elements have shown to be well suited for MRI robots. However, even avoiding ferrous materials, the high metal content on commercially available motors still cause distortions to the magnetic fields. We construct semicustom piezoelectric actuators wherein the quantity of conductive material is minimized and demonstrate that the distortion issues can be partly addressed through substituting several of these components for plastic equivalents, while maintaining motor functionality. Distortion was measured by assessing the root-mean-squared (RMS) change in position of 49 centroid points in a 12.5 mm square grid of a gelatin-filled phantom. The metal motor caused a distortion of up to 4.91 mm versus 0.55 mm for the plastic motor. An additional signal-to-noise-ratio (SNR) drop between motor off and motor spinning of approximately 20% was not statistically different for metal versus plastic (p = 0.36).
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Affiliation(s)
| | | | - Katie Y. Gandomi
- Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA 01609
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In-Bore Transrectal MRI–Guided Biopsy With Robotic Assistance in the Diagnosis of Prostate Cancer: An Analysis of 57 Patients. AJR Am J Roentgenol 2019; 213:W171-W179. [DOI: 10.2214/ajr.19.21145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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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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Carvalho PAWG, Gandomi KY, Nycz CJ, Fischer GS. DEMONSTRATION AND EXPERIMENTAL VALIDATION OF PLASTIC-ENCASED RESONANT ULTRASONIC PIEZOELECTRIC ACTUATOR FOR MRI-GUIDED SURGICAL ROBOTS. INTERNATIONAL MECHANICAL ENGINEERING CONGRESS AND EXPOSITION : [PROCEEDINGS]. INTERNATIONAL MECHANICAL ENGINEERING CONGRESS AND EXPOSITION 2019; 3. [PMID: 31363718 DOI: 10.1115/imece2018-87963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intra-operative medical imaging based on magnetic resonance imaging (MRI) coupled with robotic manipulation of surgical instruments enables precise feedback-driven procedures. Electrically powered non-ferromagnetic motors based on piezoelectric elements have shown to be well suited for MRI robots. However, even avoiding ferrous materials, the high metal content on commercially available motors still cause distortions to the magnetic fields. We construct semi-custom piezoelectric actuators wherein the quantity of conductive material is minimized and demonstrate that the distortion issues can be partly addressed through substituting several of these components for plastic equivalents, while maintaining motor functionality. Distortion was measured by assessing the RMS change in position of 49 centroid points in a 12.5mm square grid of a gelatin-filled phantom. The metal motor caused a distortion of up to 4.91mm versus 0.55mm for the plastic motor. An additional SNR drop between motor off and motor spinning of approximately 20% was not statistically different for metal versus plastic (p=0.36).
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Affiliation(s)
| | - Katie Y Gandomi
- Robotics Engineering, Worcester Polytechnic Insitute, Worcester, MA 01609
| | - Christopher J Nycz
- Robotics Engineering, Worcester Polytechnic Insitute, Worcester, MA 01609
| | - Gregory S Fischer
- Mechanical and Robotics Engineering, Worcester Polytechnic Insitute, Worcester, MA 01609
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van Luijtelaar A, Bomers J, Fütterer J. A comparison of magnetic resonance imaging techniques used to secure biopsies in prostate cancer patients. Expert Rev Anticancer Ther 2019; 19:705-716. [PMID: 31277551 DOI: 10.1080/14737140.2019.1641086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Prostate cancer (PCa) is the most common diagnosed malignancy among the male population in the United States. The incidence is increasing with an estimated amount of 175.000 cases in 2019. Areas covered: Primarily, PCa is generally detected by an elevated or rising serum prostate-specific antigen (PSA) and digital rectal examination (DRE) followed by pathological examination. Histopathology ultimately confirms the presence of PCa and determines a Gleason score. However, PSA and DRE have low specificity and sensitivity, respectively. Subsequently, accurate assessment of the aggressiveness of PCa is essential to prevent overdiagnosis and thus overtreatment of low-risk or indolent cancers. By visualizing PCa suspicious lesions and sampling them during the targeted biopsy, it is likely that the diagnostic accuracy of significant PCa improves. This article reviews the current imaging techniques used to secure biopsies in patients with a suspicion of PCa. The advantages and limitations of each technique are described. Expert opinion: Multiparametric magnetic resonance imaging (mpMRI) and subsequent-targeted biopsy have improved the diagnostic accuracy of PCa detection in men with an elevated or rising serum PSA. Prostate lesions visible on mpMRI are easily targeted during either in-bore MRI-guided biopsy, cognitive fusion biopsy or MRI-TRUS fusion biopsy.
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Affiliation(s)
- Annemarijke van Luijtelaar
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Joyce Bomers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Jurgen Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center , Nijmegen , The Netherlands
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18
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Patel NA, Li G, Shang W, Wartenberg M, Heffter T, Burdette EC, Iordachita I, Tokuda J, Hata N, Tempany CM, Fischer GS. System Integration and Preliminary Clinical Evaluation of a Robotic System for MRI-Guided Transperineal Prostate Biopsy. JOURNAL OF MEDICAL ROBOTICS RESEARCH 2019; 4:1950001. [PMID: 31485544 PMCID: PMC6726403 DOI: 10.1142/s2424905x19500016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper presents the development, preclinical evaluation, and preliminary clinical study of a robotic system for targeted transperineal prostate biopsy under direct interventional magnetic resonance imaging (MRI) guidance. The clinically integrated robotic system is developed based on a modular design approach, comprised of surgical navigation application, robot control software, MRI robot controller hardware, and robotic needle placement manipulator. The system provides enabling technologies for MRI-guided procedures. It can be easily transported and setup for supporting the clinical workflow of interventional procedures, and the system is readily extensible and reconfigurable to other clinical applications. Preclinical evaluation of the system is performed with phantom studies in a 3 Tesla MRI scanner, rehearsing the proposed clinical workflow, and demonstrating an in-plane targeting error of 1.5mm. The robotic system has been approved by the institutional review board (IRB) for clinical trials. A preliminary clinical study is conducted with the patient consent, demonstrating the targeting errors at two biopsy target sites to be 4.0mm and 3.7mm, which is sufficient to target a clinically significant tumor foci. First-in-human trials to evaluate the system's effectiveness and accuracy for MR image-guide prostate biopsy are underway.
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Affiliation(s)
- Niravkumar A Patel
- Automation and Interventional Medicine Laboratory, Worcester Polytechnic Institute, Worcester, MA 01609, USA [napatel, gfischerj]@wpi.edu
- indicates shared first authorship
| | - Gang Li
- Automation and Interventional Medicine Laboratory, Worcester Polytechnic Institute, Worcester, MA 01609, USA [napatel, gfischerj]@wpi.edu
- indicates shared first authorship
| | - Weijian Shang
- Automation and Interventional Medicine Laboratory, Worcester Polytechnic Institute, Worcester, MA 01609, USA [napatel, gfischerj]@wpi.edu
| | - Marek Wartenberg
- Automation and Interventional Medicine Laboratory, Worcester Polytechnic Institute, Worcester, MA 01609, USA [napatel, gfischerj]@wpi.edu
| | - Tamas Heffter
- Automation and Interventional Medicine Laboratory, Worcester Polytechnic Institute, Worcester, MA 01609, USA [napatel, gfischerj]@wpi.edu
| | - Everette C Burdette
- Automation and Interventional Medicine Laboratory, Worcester Polytechnic Institute, Worcester, MA 01609, USA [napatel, gfischerj]@wpi.edu
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, USA
| | - Junichi Tokuda
- Department of Radiology, Surgical Navigation and Robotics Laboratory, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA
| | - Nobuhiko Hata
- Department of Radiology, Surgical Navigation and Robotics Laboratory, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA
| | - Clare M Tempany
- Department of Radiology, Surgical Navigation and Robotics Laboratory, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory S Fischer
- Automation and Interventional Medicine Laboratory, Worcester Polytechnic Institute, Worcester, MA 01609, USA [napatel, gfischerj]@wpi.edu
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19
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In-bore biopsies of the prostate assisted by a remote-controlled manipulator at 1.5 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 32:599-605. [DOI: 10.1007/s10334-019-00751-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 02/25/2019] [Accepted: 04/29/2019] [Indexed: 01/04/2023]
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20
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Overduin CG, Heidkamp J, Rothgang E, Barentsz JO, de Lange F, Fütterer JJ. Fast 3-T MR-guided transrectal prostate biopsy using an in-room tablet device for needle guide alignment: a feasibility study. Eur Radiol 2018; 28:4824-4831. [PMID: 29789909 PMCID: PMC6182740 DOI: 10.1007/s00330-018-5497-9] [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: 02/16/2018] [Revised: 04/07/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the feasibility of adding a tablet device inside the scanner room to assist needle-guide alignment during magnetic resonance (MR)-guided transrectal prostate biopsy. METHODS Twenty patients with one cancer-suspicious region (CSR) with PI-RADS score ≥ 4 on diagnostic multiparametric MRI were prospectively enrolled. Two orthogonal scan planes of an MR fluoroscopy sequence (~3 images/s) were aligned to the CSR and needle-guide pivoting point. Targeting was achieved by manipulating the needle-guide under MR fluoroscopy feedback on the in-room tablet device. Technical feasibility and targeting success were assessed. Complications and biopsy procedure times were also recorded. RESULTS Needle-guide alignment with the in-room tablet device was technically successful in all patients and allowed sampling after a single alignment step in 19/20 (95%) CSRs (median size 14 mm, range: 4-45). Biopsy cores contained cancer in 18/20 patients. There were no per-procedural or post-biopsy complications. Using the tablet device, the mean time to first biopsy was 5.8 ± 1.0 min and the mean total procedure time was 23.7 ± 4.1 min. CONCLUSIONS Use of an in-room tablet device to assist needle-guide alignment was feasible and safe during MR-guided transrectal prostate biopsy. Initial experience indicates potential for procedure time reduction. KEY POINTS • Performing MR-guided prostate biopsy using an in-room tablet device is feasible. • CSRs could be sampled after a single alignment step in 19/20 patients. • The mean procedure time for biopsy with the tablet device was 23.7 min.
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Affiliation(s)
- Christiaan G Overduin
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands.
| | - Jan Heidkamp
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | | | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | - Frank de Lange
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands.,MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, The Netherlands
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21
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Busse H, Kahn T, Moche M. Techniques for Interventional MRI Guidance in Closed-Bore Systems. Top Magn Reson Imaging 2018; 27:9-18. [PMID: 29406410 DOI: 10.1097/rmr.0000000000000150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Efficient image guidance is the basis for minimally invasive interventions. In comparison with X-ray, computed tomography (CT), or ultrasound imaging, magnetic resonance imaging (MRI) provides the best soft tissue contrast without ionizing radiation and is therefore predestined for procedural control. But MRI is also characterized by spatial constraints, electromagnetic interactions, long imaging times, and resulting workflow issues. Although many technical requirements have been met over the years-most notably magnetic resonance (MR) compatibility of tools, interventional pulse sequences, and powerful processing hardware and software-there is still a large variety of stand-alone devices and systems for specific procedures only.Stereotactic guidance with the table outside the magnet is common and relies on proper registration of the guiding grids or manipulators to the MR images. Instrument tracking, often by optical sensing, can be added to provide the physicians with proper eye-hand coordination during their navigated approach. Only in very short wide-bore systems, needles can be advanced at the extended arm under near real-time imaging. In standard magnets, control and workflow may be improved by remote operation using robotic or manual driving elements.This work highlights a number of devices and techniques for different interventional settings with a focus on percutaneous, interstitial procedures in different organ regions. The goal is to identify technical and procedural elements that might be relevant for interventional guidance in a broader context, independent of the clinical application given here. Key challenges remain the seamless integration into the interventional workflow, safe clinical translation, and proper cost effectiveness.
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Affiliation(s)
- Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
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22
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Verma S, Choyke PL, Eberhardt SC, Oto A, Tempany CM, Turkbey B, Rosenkrantz AB. The Current State of MR Imaging-targeted Biopsy Techniques for Detection of Prostate Cancer. Radiology 2017; 285:343-356. [PMID: 29045233 DOI: 10.1148/radiol.2017161684] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Systematic transrectal ultrasonography (US)-guided biopsy is the standard approach for histopathologic diagnosis of prostate cancer. However, this technique has multiple limitations because of its inability to accurately visualize and target prostate lesions. Multiparametric magnetic resonance (MR) imaging of the prostate is more reliably able to localize significant prostate cancer. Targeted prostate biopsy by using MR imaging may thus help to reduce false-negative results and improve risk assessment. Several commercial devices are now available for targeted prostate biopsy, including in-gantry MR imaging-targeted biopsy and real-time transrectal US-MR imaging fusion biopsy systems. This article reviews the current status of MR imaging-targeted biopsy platforms, including technical considerations, as well as advantages and challenges of each technique. © RSNA, 2017.
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Affiliation(s)
- Sadhna Verma
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Peter L Choyke
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Steven C Eberhardt
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Aytekin Oto
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Clare M Tempany
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Baris Turkbey
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Andrew B Rosenkrantz
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
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23
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Su H, Shang W, Li G, Patel N, Fischer GS. An MRI-Guided Telesurgery System Using a Fabry-Perot Interferometry Force Sensor and a Pneumatic Haptic Device. Ann Biomed Eng 2017; 45:1917-1928. [PMID: 28447178 PMCID: PMC5529224 DOI: 10.1007/s10439-017-1839-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 04/20/2017] [Indexed: 12/23/2022]
Abstract
This paper presents a surgical master-slave teleoperation system for percutaneous interventional procedures under continuous magnetic resonance imaging (MRI) guidance. The slave robot consists of a piezoelectrically actuated 6-degree-of-freedom (DOF) robot for needle placement with an integrated fiber optic force sensor (1-DOF axial force measurement) using the Fabry-Perot interferometry (FPI) sensing principle; it is configured to operate inside the bore of the MRI scanner during imaging. By leveraging the advantages of pneumatic and piezoelectric actuation in force and position control respectively, we have designed a pneumatically actuated master robot (haptic device) with strain gauge based force sensing that is configured to operate the slave from within the scanner room during imaging. The slave robot follows the insertion motion of the haptic device while the haptic device displays the needle insertion force as measured by the FPI sensor. Image interference evaluation demonstrates that the telesurgery system presents a signal to noise ratio reduction of less than 17% and less than 1% geometric distortion during simultaneous robot motion and imaging. Teleoperated needle insertion and rotation experiments were performed to reach 10 targets in a soft tissue-mimicking phantom with 0.70 ± 0.35 mm Cartesian space error.
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Affiliation(s)
- Hao Su
- Wyss Institute for Biologically Inspired Engineering and the John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA.
| | - Weijian Shang
- Automation and Interventional Medicine Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Gang Li
- Automation and Interventional Medicine Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Niravkumar Patel
- Automation and Interventional Medicine Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
| | - Gregory S Fischer
- Automation and Interventional Medicine Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA
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24
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Stoianovici D, Jun C, Lim S, Li P, Petrisor D, Fricke S, Sharma K, Cleary K. Multi-Imager Compatible, MR Safe, Remote Center of Motion Needle-Guide Robot. IEEE Trans Biomed Eng 2017; 65:165-177. [PMID: 28459678 DOI: 10.1109/tbme.2017.2697766] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report the development of a new robotic system for direct image-guided interventions (DIGI; images acquired at the time of the intervention). The manipulator uses our previously reported pneumatic step motors and is entirely made of electrically nonconductive, nonmetallic, and nonmagnetic materials. It orients a needle-guide with two degrees of freedom (DoF) about a fulcrum point located below the guide using an innovative remote center of motion parallelogram type mechanism. The depth of manual needle insertion is preset with a third DoF, located remotely of the manipulator. Special consideration was given to the kinematic accuracy and the structural stiffness. The manipulator includes registration markers for image-to-robot registration. Based on the images, it may guide needles, drills, or other slender instruments to a target (OD < 10 mm). Comprehensive preclinical tests were performed. The manipulator is MR safe (ASTM F2503-13). Electromagnetic compatibility (EMC) testing (IEC 60601-1-2) of the system shows that it does not conduct or radiate EM emissions. The change in the signal to noise ratio of the MRI due to the presence and motion of the robot in the scanner is below 1%. The structural stiffness at the needle-guide is 33 N/mm. The angular accuracy and precision of the manipulator itself are 0.177° and 0.077°. MRI-guided targeting accuracy and precision in vitro were 1.71 mm and 0.51 mm, at an average target depth of ∼38 mm, with no adjustments. The system may be suitable for DIGI where [mm] accuracy lateral to the needle (2D) or [mm] in 3D is acceptable. The system is also multi-imager compatible and could be used with other imaging modalities.
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25
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Stoianovici D, Kim C, Petrisor D, Jun C, Lim S, Ball MW, Ross A, Macura KJ, Allaf M. MR Safe Robot, FDA Clearance, Safety and Feasibility Prostate Biopsy Clinical Trial. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2017; 22:115-126. [PMID: 28867930 PMCID: PMC5578622 DOI: 10.1109/tmech.2016.2618362] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Compatibility of mechatronic devices with the MR environment has been a very challenging engineering task. After over a decade of developments, we report the successful translation to clinical trials of our MR Safe robot technology. MrBot is a 6-degree-of-freedom, pneumatically actuated robot for transperineal prostate percutaneous access, built exclusively of electrically nonconductive and nonmagnetic materials. Its extensive pre-clinical tests have been previously reported. Here, we present the latest technology developments, an overview of the regulatory protocols, and technically related results of the clinical trial. The FDA has approved the MrBot for the biopsy trial, which was successfully performed in 5 patients. With no trajectory corrections, and no unsuccessful attempts to target a site, the robot achieved an MRI based needle targeting accuracy of 2.55 mm. To the best of our knowledge, this is the first robot approved by the FDA for the MR environment. The results confirm that it is possible to perform safe and accurate robotic manipulation in the MRI scanner, and the development of MR Safe robots is no longer a daunting technical challenge.
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Affiliation(s)
| | - Chunwoo Kim
- Urology Department, Johns Hopkins University Baltimore, MD
| | - Doru Petrisor
- Urology Department, Johns Hopkins University Baltimore, MD
| | - Changhan Jun
- Urology Department, Johns Hopkins University Baltimore, MD
| | - Sunghwan Lim
- Urology Department, Johns Hopkins University Baltimore, MD
| | - Mark W. Ball
- Urology Department, Johns Hopkins University Baltimore, MD
| | - Ashley Ross
- Urology Department, Johns Hopkins University Baltimore, MD
| | | | - Mohamad Allaf
- Urology Department, Johns Hopkins University Baltimore, MD
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Chen Y, Squires A, Seifabadi R, Xu S, Agrawal H, Bernardo M, Pinto P, Choyke P, Wood B, Tse ZTH. Robotic System for MRI-guided Focal Laser Ablation in the Prostate. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2017; 22:107-114. [PMID: 31080341 PMCID: PMC6506217 DOI: 10.1109/tmech.2016.2611570] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
MRI-conditional robotic platforms have proved to be an effective approach for image guided interventions. In this study, a computer-assisted, pneumatically-actuated robot was designed, built, and tested for MRI-guided prostate cancer focal laser ablation (FLA). The robotic manipulator provides two active planar degrees of freedom (DoFs) by using a customized CoreXY frame, and one passive rotational DoF. A remote insertion mechanism improves the surgical workflow by keeping the patients inside the scanner during needle insertion. The robotic manipulator was tested in a 3T MR scanner to evaluate its MR compliance, and the results demonstrated that the signal-to-noise ratio (SNR) variation was less than 8%. The in-scanner template positioning accuracy test demonstrated that the manipulator achieves high targeting accuracy with a mean error of 0.46 mm and a standard deviation of 0.25mm. Phantom studies have shown that the needle insertion accuracy of the manipulator is within 2mm (Mean = 1.7mm, StD = 0.2mm).
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Affiliation(s)
- Yue Chen
- College of Engineering, The University of Georgia, Athens, GA, 30605, USA
| | - Alexander Squires
- College of Engineering, The University of Georgia, Athens, GA, 30605, USA
| | - Reza Seifabadi
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sheng Xu
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Harsh Agrawal
- Philips Research North America, Briarcliff, NY, 10510, USA
| | - Marcelino Bernardo
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Pinto
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Choyke
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Bradford Wood
- Center for Interventional Oncology, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Zion Tsz Ho Tse
- College of Engineering, The University of Georgia, Athens, GA, 30605, USA
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Su H, Li G, Rucker DC, Webster Iii RJ, Fischer GS. A Concentric Tube Continuum Robot with Piezoelectric Actuation for MRI-Guided Closed-Loop Targeting. Ann Biomed Eng 2016; 44:2863-2873. [PMID: 26983842 PMCID: PMC5479710 DOI: 10.1007/s10439-016-1585-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Abstract
This paper presents the design, modeling and experimental evaluation of a magnetic resonance imaging (MRI)-compatible concentric tube continuum robotic system. This system enables MRI-guided deployment of a precurved and steerable concentric tube continuum mechanism, and is suitable for clinical applications where a curved trajectory is needed. This compact 6 degree-of-freedom (DOF) robotic system is piezoelectrically-actuated, and allows simultaneous robot motion and imaging with no visually observable image artifact. The targeting accuracy is evaluated with optical tracking system and gelatin phantom under live MRI-guidance with Root Mean Square (RMS) errors of 1.94 and 2.17 mm respectively. Furthermore, we demonstrate that the robot has kinematic redundancy to reach the same target through different paths. This was evaluated in both free space and MRI-guided gelatin phantom trails, with RMS errors of 0.48 and 0.59 mm respectively. As the first of its kind, MRI-guided targeted concentric tube needle placements with ex vivo porcine liver are demonstrated with 4.64 mm RMS error through closed-loop control of the piezoelectrically-actuated robot.
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Affiliation(s)
- Hao Su
- Wyss Institute for Biologically Inspired Engineering and the John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA.
| | - Gang Li
- Automation and Interventional Medicine (AIM) Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA, 01609, USA
| | - D Caleb Rucker
- Vanderbilt Institute in Surgery and Engineering, Vanderbilt University, Nashville, TN, 37235, USA
| | | | - Gregory S Fischer
- Automation and Interventional Medicine (AIM) Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA, 01609, USA
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Bomers JGR, Bosboom DGH, Tigelaar GH, Sabisch J, Fütterer JJ, Yakar D. Feasibility of a 2 nd generation MR-compatible manipulator for transrectal prostate biopsy guidance. Eur Radiol 2016; 27:1776-1782. [PMID: 27436021 PMCID: PMC5334446 DOI: 10.1007/s00330-016-4504-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/18/2016] [Accepted: 07/04/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the feasibility of a 2nd generation MR-compatible, remote-controlled manipulator (RCM) as an aid to perform MR-guided transrectal prostate biopsy in males with suspicion of prostate cancer (PCa). METHODS This prospective phase I study was approved by the local ethical committee and written informed consent was obtained from each patient. Twenty patients with ≥1 cancer suspicious region (CSR) with a PI-RADS score of ≥3 detected on the diagnostic multi-parametric MRI and no prior prostate treatment underwent MR-guided biopsy with the aid of the RCM. Complications were classified according to the modified Clavien system for reporting surgical complications. For evaluation of the workflow, procedure- and manipulation times were recorded. RESULTS All CSR's (n=20) were reachable with the MR-compatible RCM and the cancer detection rate was 70 %. The median procedure time was 36:44 minutes (range, 23 - 61 minutes) and the median manipulation time for needle guide movement was 5:48 minutes (range, 1:15 - 18:35 minutes). Two Clavien grade 1 complications were reported. CONCLUSIONS It is feasible and safe to perform transrectal MR-guided prostate biopsy using a MR-compatible RCM as an aid. It is a fast and efficient way to biopsy suspicious prostate lesions with a minimum number of biopsies per patient. KEY POINTS • It is feasible to perform transrectal prostate biopsy using a MR-compatible RCM. • Using a RCM for MR-guided biopsy is safe, fast, and efficient. • All cancer suspicious regions were reachable with the RCM.
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Affiliation(s)
- J G R Bomers
- Department of Radiology, route 766, Radboud University Nijmegen Medical Center, P.O Box 9101, 6500HB, Nijmegen, The Netherlands.
| | - D G H Bosboom
- Department of Radiology, route 766, Radboud University Nijmegen Medical Center, P.O Box 9101, 6500HB, Nijmegen, The Netherlands.,Soteria Medical, Arnhem, The Netherlands
| | | | - J Sabisch
- Soteria Medical, Arnhem, The Netherlands
| | - J J Fütterer
- Department of Radiology, route 766, Radboud University Nijmegen Medical Center, P.O Box 9101, 6500HB, Nijmegen, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - D Yakar
- Department of Radiology, route 766, Radboud University Nijmegen Medical Center, P.O Box 9101, 6500HB, Nijmegen, The Netherlands
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Fütterer JJ, Moche M, Busse H, Yakar D. In-Bore MR-Guided Biopsy Systems and Utility of PI-RADS. Top Magn Reson Imaging 2016; 25:119-123. [PMID: 27187168 DOI: 10.1097/rmr.0000000000000090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A diagnostic dilemma exists in cases wherein a patient with clinical suspicion for prostate cancer has a negative transrectal ultrasound-guided biopsy session. Although transrectal ultrasound-guided biopsy is the standard of care, a paradigm shift is being observed. In biopsy-naive patients and patients with at least 1 negative biopsy session, multiparametric magnetic resonance imaging (MRI) is being utilized for tumor detection and subsequent targeting. Several commercial devices are now available for targeted prostate biopsy ranging from transrectal ultrasound-MR fusion biopsy to in bore MR-guided biopsy. In this review, we will give an update on the current status of in-bore MRI-guided biopsy systems and discuss value of prostate imaging-reporting and data system (PIRADS).
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Affiliation(s)
- Jurgen J Fütterer
- *Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen †MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands ‡Department of Diagnostic and Interventional Radiology, University Hospital, Leipzig, Germany
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Closed-Bore Interventional MRI: Percutaneous Biopsies and Ablations. AJR Am J Roentgenol 2015; 205:W400-10. [DOI: 10.2214/ajr.15.14732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Su H, Shang W, Cole G, Li G, Harrington K, Camilo A, Tokuda J, Tempany CM, Hata N, Fischer GS. Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2015; 20:1920-1932. [PMID: 26412962 PMCID: PMC4580290 DOI: 10.1109/tmech.2014.2359413] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper presents a fully-actuated robotic system for percutaneous prostate therapy under continuously acquired live magnetic resonance imaging (MRI) guidance. The system is composed of modular hardware and software to support the surgical workflow of intra-operative MRI-guided surgical procedures. We present the development of a 6-degree-of-freedom (DOF) needle placement robot for transperineal prostate interventions. The robot consists of a 3-DOF needle driver module and a 3-DOF Cartesian motion module. The needle driver provides needle cannula translation and rotation (2-DOF) and stylet translation (1-DOF). A custom robot controller consisting of multiple piezoelectric motor drivers provides precision closed-loop control of piezoelectric motors and enables simultaneous robot motion and MR imaging. The developed modular robot control interface software performs image-based registration, kinematics calculation, and exchanges robot commands and coordinates between the navigation software and the robot controller with a new implementation of the open network communication protocol OpenIGTLink. Comprehensive compatibility of the robot is evaluated inside a 3-Tesla MRI scanner using standard imaging sequences and the signal-to-noise ratio (SNR) loss is limited to 15%. The image deterioration due to the present and motion of robot demonstrates unobservable image interference. Twenty-five targeted needle placements inside gelatin phantoms utilizing an 18-gauge ceramic needle demonstrated 0.87 mm root mean square (RMS) error in 3D Euclidean distance based on MRI volume segmentation of the image-guided robotic needle placement procedure.
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Affiliation(s)
- Hao Su
- Philips Research North America, were with the Automation and Interventional Medicine (AIM) Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute
| | - Weijian Shang
- Automation and Interventional Medicine (AIM) Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Gregory Cole
- Philips Research North America, were with the Automation and Interventional Medicine (AIM) Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute
| | - Gang Li
- Automation and Interventional Medicine (AIM) Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Kevin Harrington
- Automation and Interventional Medicine (AIM) Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Alexander Camilo
- Automation and Interventional Medicine (AIM) Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Junichi Tokuda
- National Center for Image Guided Therapy (NCIGT), Brigham and Women's Hospital, Department of Radiology, Harvard Medical School, Boston, MA, 02115 USA
| | - Clare M. Tempany
- National Center for Image Guided Therapy (NCIGT), Brigham and Women's Hospital, Department of Radiology, Harvard Medical School, Boston, MA, 02115 USA
| | - Nobuhiko Hata
- National Center for Image Guided Therapy (NCIGT), Brigham and Women's Hospital, Department of Radiology, Harvard Medical School, Boston, MA, 02115 USA
| | - Gregory S. Fischer
- Automation and Interventional Medicine (AIM) Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA ()
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Abayazid M, Pacchierotti C, Moreira P, Alterovitz R, Prattichizzo D, Misra S. Experimental evaluation of co-manipulated ultrasound-guided flexible needle steering. Int J Med Robot 2015; 12:219-30. [PMID: 26173754 DOI: 10.1002/rcs.1680] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 05/15/2015] [Accepted: 05/16/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND A teleoperation system for bevel-tipped flexible needle steering has been evaluated. Robotic systems have been exploited as the main tool to achieve high accuracy and reliability. However, for reasons of safety and acceptance by the surgical community, keeping the physician tightly in the loop is preferable. METHODS The system uses ultrasound imaging, path planning, and control to compute the desired needle orientation during the insertion and intuitively passes this information to the operator, who teleoperates the motion of the needle's tip. Navigation cues about the computed orientation are provided through haptic and visual feedback to the operator to steer the needle. RESULTS The targeting accuracy of several co-manipulation strategies were studied in four sets of experiments involving human subjects with clinical backgrounds. CONCLUSIONS Experimental results show that receiving feedback regarding the desired needle orientation improves the targeting accuracy by a factor of 9 with respect to manual insertions. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Momen Abayazid
- MIRA-Institute for Biomedical Technology and Technical Medicine, Department of Biomechanical Engineering, Surgical Robotics Laboratory, University of Twente, Enschede, The Netherlands
| | - Claudio Pacchierotti
- Department of Information Engineering and Mathematics, University of Siena, and with the Department of Advanced Robotics, Istituto Italiano di Tecnologia, Italy
| | - Pedro Moreira
- MIRA-Institute for Biomedical Technology and Technical Medicine, Department of Biomechanical Engineering, Surgical Robotics Laboratory, University of Twente, Enschede, The Netherlands
| | - Ron Alterovitz
- Department of Computer Science, University of North Carolina at Chapel Hill, USA
| | - Domenico Prattichizzo
- Department of Information Engineering and Mathematics, University of Siena, and with the Department of Advanced Robotics, Istituto Italiano di Tecnologia, Italy
| | - Sarthak Misra
- MIRA-Institute for Biomedical Technology and Technical Medicine, Department of Biomechanical Engineering, Surgical Robotics Laboratory, University of Twente, Enschede, The Netherlands.,Department of Biomedical Engineering, University of Groningen and University Medical Centre, Groningen, The Netherlands
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Tilak G, Tuncali K, Song SE, Tokuda J, Olubiyi O, Fennessy F, Fedorov A, Penzkofer T, Tempany C, Hata N. 3T MR-guided in-bore transperineal prostate biopsy: A comparison of robotic and manual needle-guidance templates. J Magn Reson Imaging 2014; 42:63-71. [PMID: 25263213 DOI: 10.1002/jmri.24770] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 09/11/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To demonstrate the utility of a robotic needle-guidance template device as compared to a manual template for in-bore 3T transperineal magnetic resonance imaging (MRI)-guided prostate biopsy. MATERIALS AND METHODS This two-arm mixed retrospective-prospective study included 99 cases of targeted transperineal prostate biopsies. The biopsy needles were aimed at suspicious foci noted on multiparametric 3T MRI using manual template (historical control) as compared with a robotic template. The following data were obtained: the accuracy of average and closest needle placement to the focus, histologic yield, percentage of cancer volume in positive core samples, complication rate, and time to complete the procedure. RESULTS In all, 56 cases were performed using the manual template and 43 cases were performed using the robotic template. The mean accuracy of the best needle placement attempt was higher in the robotic group (2.39 mm) than the manual group (3.71 mm, P < 0.027). The mean core procedure time was shorter in the robotic (90.82 min) than the manual group (100.63 min, P < 0.030). Percentage of cancer volume in positive core samples was higher in the robotic group (P < 0.001). Cancer yields and complication rates were not statistically different between the two subgroups (P = 0.557 and P = 0.172, respectively). CONCLUSION The robotic needle-guidance template helps accurate placement of biopsy needles in MRI-guided core biopsy of prostate cancer.
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Affiliation(s)
- Gaurie Tilak
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sang-Eun Song
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Olutayo Olubiyi
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fiona Fennessy
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andriy Fedorov
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tobias Penzkofer
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lahdensuo K, Mirtti T, Petas A, Rannikko A. Performance of transrectal prostate biopsies in detecting tumours and implications for focal therapy. Scand J Urol 2014; 49:90-6. [DOI: 10.3109/21681805.2014.936494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Tokuda J, Song SE, Tuncali K, Tempany C, Hata N. Configurable automatic detection and registration of fiducial frames for device-to-image registration in MRI-guided prostate interventions. ACTA ACUST UNITED AC 2014; 16:355-62. [PMID: 24505781 DOI: 10.1007/978-3-642-40760-4_45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
We propose a novel automatic fiducial frame detection and registration method for device-to-image registration in MRI-guided prostate interventions. The proposed method does not require any manual selection of markers, and can be applied to a variety of fiducial frames, which consist of multiple cylindrical MR-visible markers placed in different orientations. The key idea is that automatic extraction of linear features using a line filter is more robust than that of bright spots by thresholding; by applying a line set registration algorithm to the detected markers, the frame can be registered to the MRI. The method was capable of registering the fiducial frame to the MRI with an accuracy of 1.00 +/- 0.73 mm and 1.41 +/- 1.06 degrees in a phantom study, and was sufficiently robust to detect the fiducial frame in 98% of images acquired in clinical cases despite the existence of anatomical structures in the field of view.
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Affiliation(s)
- Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Sang-Eun Song
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Clare Tempany
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Overduin CG, Fütterer JJ, Barentsz JO. MRI-guided biopsy for prostate cancer detection: a systematic review of current clinical results. Curr Urol Rep 2014; 14:209-13. [PMID: 23568624 DOI: 10.1007/s11934-013-0323-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In-bore magnetic resonance-guided biopsy (MRGB) has been increasingly used in clinical practice to detect prostate cancer (PCa). This review summarizes the current clinical results of this biopsy method. A systematic literature search was performed in the PubMed and Embase databases. Of 2,035 identified records, 49 required full review. In all, ten unique studies reporting clinical results of MRGB could be included. Reported PCa detection rates ranged from 8 to 59 % (median 42 %). The majority of tumors detected by MRGB were clinically significant (81-93 %). Most frequent complications of MRGB are transient hematuria (1-24 %) and short-term perirectal bleeding (11-17 %). Major complications are rare. Based on the reviewed literature, MRGB can be regarded an accurate and safe diagnostic tool to detect clinically significant PCa. However, as general availability is limited, this procedure should be reserved for specific patients. Appropriate indications will have to be determined.
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Affiliation(s)
- Christiaan G Overduin
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, P.O. Box 9101 (766), 6500 HB, Nijmegen, the Netherlands.
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1.5-T magnetic resonance-guided transgluteal biopsies of the prostate in patients with clinically suspected prostate cancer: technique and feasibility. Invest Radiol 2014; 48:458-63. [PMID: 23385402 DOI: 10.1097/rli.0b013e31827c394b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to examine the feasibility and safety of magnetic resonance-guided prostate biopsy (MRGBx) with a transgluteal approach in patients with cancer suspicious prostatic lesions. MATERIALS AND METHODS This study was approved by the ethical committee. A total of 25 men with clinically suspected prostate cancer with increased prostate-specific antigen levels and at least 1 previous negative transrectal ultrasound-guided prostatic biopsy (TRUSBx) underwent diagnostic magnetic resonance (MR) imaging of the prostate. Cancer suspicious regions (CSR) were identified, and MRGBx with a transgluteal approach in a large closed-bore 1.5-T MR system was manually performed in coaxial technique, using transversal fat-suppressed T2-weighted true fast imaging with steady-state free precession sequences. Success rate, biopsy findings, side effects, procedure time, number of acquisitions for the repositioning of the needle guide, and length of the biopsy channel were documented. Follow-up was performed 24 months after the procedure. RESULTS In diagnostic MR imaging of the prostate, a total of 40 CSRs were detected in 25 patients. All MRGBx procedures were technically successful and all CSRs were biopsied. The mean number of core biopsies per CSR was 3.3 ± 1.5 (range, 1-7). Histopathological analysis revealed adenocarcinoma in 35% (14/40), acute or chronic prostatitis in 30% (12/40), adenofibromyomatous changes in 22.5% (9/40), and no identifiable pathology in 17.5% (7/40) of CSRs, with a pathological overlap for chronic prostatitis and adenofibromyomatous changes in 1 patient with biopsies in 2 CSRs. No missed prostate cancer after MR-guided biopsy in clinical follow-up was detected. Mean procedure time was 31 ± 7 minutes (range, 21-46 minutes). Side effects were hematuria (n = 7), hematospermia (n = 3), combined hematuria/hematospermia (n = 2), and infection (n=1). CONCLUSION Magnetic resonance-guided prostate biopsy of the prostate gland with a transgluteal approach is feasible, safe, and a promising technique for histological clarification of cancer suspicious lesions in patients with increased prostate-specific antigen levels after negative TRUSBx. Magnetic resonance-guided prostate biopsy offers a reasonable alternative to repeated TRUSBx for histological clarification of prostate cancer.
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Srimathveeravalli G, Kim C, Petrisor D, Ezell P, Coleman J, Hricak H, Solomon SB, Stoianovici D. MRI-safe robot for targeted transrectal prostate biopsy: animal experiments. BJU Int 2013; 113:977-85. [PMID: 24118992 DOI: 10.1111/bju.12335] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the feasibility and safety of using a magnetic resonance imaging (MRI)-safe robot for assisting MRI-guided transrectal needle placement and biopsy in the prostate, using a canine model. To determine the accuracy and precision afforded by the use of the robot while targeting a desired location in the organ. MATERIALS AND METHODS In a study approved by the Institutional Animal Care and Use Committee, six healthy adult male beagles with prostates of at least 15 × 15 mm in size at the largest transverse section were chosen for the procedure. The probe portion of the robot was placed into the rectum of the dog, images were acquired and image-to-robot registration was performed. Images acquired after placement of the robot were reviewed and a radiologist selected targets for needle placement in the gland. Depending on the size of the prostate, up to a maximum of six needle placements were performed on each dog. After needle placement, robot-assisted core biopsies were performed on four dogs that had larger prostate volumes and extracted cores were analysed for potential diagnostic value. RESULTS Robot-assisted MRI-guided needle placements were performed to target a total of 30 locations in six dogs, achieving a targeting accuracy of 2.58 mm (mean) and precision of 1.31 mm (SD). All needle placements were successfully completed on the first attempt. The mean time required to select a desired target location in the prostate, align the needle guide to that point, insert the needle and perform the biopsy was ∼ 3 min. For this targeting accuracy study, the inserted needle was also imaged after its placement in the prostate, which took an additional 6-8 min. Signal-to-noise ratio analysis indicated that the presence of the robot within the scanner bore had minimal impact on the quality of the images acquired. Analysis of intact biopsy core samples indicated that the samples contained prostatic tissues, appropriate for making a potential diagnosis. Dogs used in the study did not experience device- or procedure-related complications. CONCLUSIONS Results from this preclinical pilot animal study suggest that MRI-targeted transrectal biopsies are feasible to perform and this procedure may be safely assisted by an MRI-safe robotic device.
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Shang W, Su H, Li G, Fischer GS. Teleoperation System with Hybrid Pneumatic-Piezoelectric Actuation for MRI-Guided Needle Insertion with Haptic Feedback. PROCEEDINGS OF THE ... IEEE/RSJ INTERNATIONAL CONFERENCE ON INTELLIGENT ROBOTS AND SYSTEMS. IEEE/RSJ INTERNATIONAL CONFERENCE ON INTELLIGENT ROBOTS AND SYSTEMS 2013; 2013:4092-4098. [PMID: 25126446 DOI: 10.1109/iros.2013.6696942] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents a surgical master-slave tele-operation system for percutaneous interventional procedures under continuous magnetic resonance imaging (MRI) guidance. This system consists of a piezoelectrically actuated slave robot for needle placement with integrated fiber optic force sensor utilizing Fabry-Perot interferometry (FPI) sensing principle. The sensor flexure is optimized and embedded to the slave robot for measuring needle insertion force. A novel, compact opto-mechanical FPI sensor interface is integrated into an MRI robot control system. By leveraging the complementary features of pneumatic and piezoelectric actuation, a pneumatically actuated haptic master robot is also developed to render force associated with needle placement interventions to the clinician. An aluminum load cell is implemented and calibrated to close the impedance control loop of the master robot. A force-position control algorithm is developed to control the hybrid actuated system. Teleoperated needle insertion is demonstrated under live MR imaging, where the slave robot resides in the scanner bore and the user manipulates the master beside the patient outside the bore. Force and position tracking results of the master-slave robot are demonstrated to validate the tracking performance of the integrated system. It has a position tracking error of 0.318mm and sine wave force tracking error of 2.227N.
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Affiliation(s)
- Weijian Shang
- Automation and Interventional Medicine (AIM) Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Hao Su
- Automation and Interventional Medicine (AIM) Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Gang Li
- Automation and Interventional Medicine (AIM) Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
| | - Gregory S Fischer
- Automation and Interventional Medicine (AIM) Robotics Laboratory, Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, USA
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Stoianovici D, Kim C, Srimathveeravalli G, Sebrecht P, Petrisor D, Coleman J, Solomon SB, Hricak H. MRI-Safe Robot for Endorectal Prostate Biopsy. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2013; 19:1289-1299. [PMID: 25378897 PMCID: PMC4219418 DOI: 10.1109/tmech.2013.2279775] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This paper reports the development of an MRI-Safe robot for direct (interventional) MRI-guided endorectal prostate biopsy. The robot is constructed of nonmagnetic and electrically nonconductive materials, and is electricity free, using pneumatic actuation and optical sensors. Targeting biopsy lesions of MRI abnormality presents substantial clinical potential for the management of prostate cancer. The paper describes MRI-Safe requirements, presents the kinematic architecture, design and construction of the robot, and a comprehensive set of preclinical tests for MRI compatibility and needle targeting accuracy. The robot has a compact and simple 3 degree-of-freedom (DoF) structure, two for orienting a needle-guide and one to preset the depth of needle insertion. The actual insertion is performed manually through the guide and up to the preset depth. To reduce the complexity and size of the robot next to the patient, the depth setting DoF is remote. Experimental results show that the robot is safe to use in any MRI environment (MRI-Safe). Comprehensive MRI tests show that the presence and motion of the robot in the MRI scanner cause virtually no image deterioration or signal to noise ratio (SNR) change. Robot's accuracy in bench test, CT-guided in-vitro, MRI-guided in-vitro and animal tests are 0.37mm, 1.10mm, 2.09mm, and 2.58mm respectively. These values are acceptable for clinical use.
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Affiliation(s)
- Dan Stoianovici
- Johns Hopkins University, Urology Department, Robotics Laboratory ( http://urobotics.urology.jhu.edu/ ), Baltimore, MD
| | - Chunwoo Kim
- Johns Hopkins University, Urology Department, Robotics Laboratory ( http://urobotics.urology.jhu.edu/ ), Baltimore, MD
| | | | - Peter Sebrecht
- Johns Hopkins University, Urology Department, Robotics Laboratory ( http://urobotics.urology.jhu.edu/ ), Baltimore, MD
| | - Doru Petrisor
- Johns Hopkins University, Urology Department, Robotics Laboratory ( http://urobotics.urology.jhu.edu/ ), Baltimore, MD
| | - Jonathan Coleman
- Radiology Department, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen B Solomon
- Radiology Department, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hedvig Hricak
- Radiology Department, Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
Robotic prostatectomy is a common surgical treatment for men with prostate cancer, with some studies estimating that 80% of prostatectomies now performed in the USA are done so robotically. Despite the technical advantages offered by robotic systems, functional and oncological outcomes of prostatectomy can still be improved further. Alternative minimally invasive treatments that have also adopted robotic platforms include brachytherapy and high-intensity focused ultrasonography (HIFU). These techniques require real-time image guidance--such as ultrasonography or MRI--to be truly effective; issues with software compatibility as well as image registration and tracking currently limit such technologies. However, image-guided robotics is a fast-growing area of research that combines the improved ergonomics of robotic systems with the improved visualization of modern imaging modalities. Although the benefits of a real-time image-guided robotic system to improve the precision of surgical interventions are being realized, the clinical usefulness of many of these systems remains to be seen.
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Li L, Wang L, Feng Z, Hu Z, Wang G, Yuan X, Wang H, Hu D. Prostate cancer magnetic resonance imaging (MRI): multidisciplinary standpoint. Quant Imaging Med Surg 2013; 3:100-12. [PMID: 23630657 DOI: 10.3978/j.issn.2223-4292.2013.03.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 03/12/2013] [Indexed: 12/11/2022]
Abstract
Prostate cancer is the most common cancer diagnosed in men and a leading cause of death. Accurate assessment is a prerequisite for optimal clinical management and therapy selection of prostate cancer. There are several parameters and nomograms to differentiate between patients with clinically insignificant disease and patients in need of treatment. Magnetic resonance imaging (MRI) is a technique which provides more detailed anatomical images due to high spatial resolution, superior contrast resolution, and multiplanar capability. State-of-the-art MRI techniques, such as diffusion weighted imaging (DWI), MR spectroscopic imaging (MRSI), dynamic contrast enhanced MRI (DCE-MRI), improve interpretation of prostate cancer imaging. In this article, we review the major role of MRI in the advanced management of prostate cancer to noninvasively improve tumor staging, biologic potential, treatment planning, therapy response, local recurrence, and to guide target biopsy for clinical suspected cancer with previous negative biopsy. Finally, future challenges and opportunities in prostate cancer management in the area of functional MRI are discussed as well.
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Affiliation(s)
- Liang Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Li B, Du Y, Yang H, Huang Y, Meng J, Xiao D. Magnetic resonance imaging for prostate cancer clinical application. Chin J Cancer Res 2013; 25:240-9. [PMID: 23592906 DOI: 10.3978/j.issn.1000-9604.2013.03.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 12/14/2012] [Indexed: 01/16/2023] Open
Abstract
As prostate cancer is a biologically heterogeneous disease for which a variety of treatment options are available, the major objective of prostate cancer imaging is to achieve more precise disease characterization. In clinical practice, magnetic resonance imaging (MRI) is one of the imaging tools for the evaluation of prostate cancer, the fusion of MRI or dynamic contrast-enhanced MRI (DCE-MRI) with magnetic resonance spectroscopic imaging (MRSI) is improving the evaluation of cancer location, size, and extent, while providing an indication of tumor aggressiveness. This review summarizes the role of MRI in the application of prostate cancer and describes molecular MRI techniques (including MRSI and DCE-MRI) for aiding prostate cancer management.
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Affiliation(s)
- Bing Li
- Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China ; Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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Fiard G, Hohn N, Descotes JL, Rambeaud JJ, Troccaz J, Long JA. Targeted MRI-guided prostate biopsies for the detection of prostate cancer: initial clinical experience with real-time 3-dimensional transrectal ultrasound guidance and magnetic resonance/transrectal ultrasound image fusion. Urology 2013; 81:1372-8. [PMID: 23540865 DOI: 10.1016/j.urology.2013.02.022] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/29/2013] [Accepted: 02/15/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To prove the feasibility and evaluate the initial clinical results of targeted prostate biopsies using the Urostation novel platform using magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) registration to help steer the biopsy needle to suspicious areas. METHODS We prospectively included 30 patients for suspicion of prostate cancer from November 2011 to August 2012. All patients were previously evaluated by a multiparametric MRI, interpreted by a single radiologist who attributed a Prostate Imaging-Reporting and Data System (PI-RADS) score to each lesion. A conventional 12-core randomized biopsy protocol was performed and 2 additional targeted biopsies were performed on suspicious area(s). The results of randomized and targeted biopsies were compared. RESULTS Among the 30 patients, suspicious area(s) were found on MRI in 20 cases (67%). Median procedure time was 23 minutes. Targeting success rate (biopsy visualized inside the target) was 83%, with at least 1 biopsy reaching the target in all cases. Prostate cancer was detected in 14 cases (47%), including 11 cases with an abnormal MRI. Targeted biopsies detected cancer in all 11 cases and all but 1 were clinically significant. Randomized biopsies detected 10 of these 11 cases, and 3 more cases that MRI considered normal. Sensitivity to detect a significant cancer was 91% in both modalities. CONCLUSION This initial clinical study showed encouraging results for targeted MRI-guided prostate biopsies using MRI-TRUS fusion. Although further studies are needed to determine the role of prostate MRI before biopsy and the relevance of targeted biopsies, the Urostation is an MRI-TRUS fusion device that has good accuracy for targeting suspicious areas on MRI.
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Affiliation(s)
- Gaelle Fiard
- Urology Department, Grenoble University Hospital, Grenoble, France
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Bomers JGR, Yakar D, Overduin CG, Sedelaar JPM, Vergunst H, Barentsz JO, de Lange F, Fütterer JJ. MR imaging-guided focal cryoablation in patients with recurrent prostate cancer. Radiology 2013; 268:451-60. [PMID: 23525206 DOI: 10.1148/radiol.13121291] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the feasibility of magnetic resonance (MR) imaging-guided focal cryoablation in patients with locally recurrent prostate cancer after radiation therapy. MATERIALS AND METHODS This was a prospective study, and informed consent was obtained from all patients. Ten consecutive patients with histopathologically proved recurrent prostate cancer after radiation therapy, without evidence of distant metastases, were treated while under general anesthesia in a 1.5-T MR unit. A urethral warmer was inserted. Cryoneedles were transperineally inserted under real-time MR imaging. Then, a rectal warmer was inserted. Ice ball growth was continuously monitored under MR imaging guidance. Two freeze-thaw cycles were performed. Follow-up consisted of a visit to the urologist, measurement of prostate-specific antigen level, and multiparametric MR imaging at 3, 6, and 12 months. Potential complications were recorded. RESULTS All patients were successfully treated. In one patient, the urethral warmer could not be inserted and the procedure was cancelled. Two months later, the procedure was successfully repeated. Another patient had urinary retention. Follow-up data were available for all patients. A local recurrence or remnant tumor was found in two patients after 6 months and in another patient after 12 months. These three patients underwent successful retreatment with MR imaging-guided focal cryoablation. CONCLUSION MR imaging-guided focal cryoablation of recurrent prostate cancer after radiation therapy is feasible and safe. Initial results are promising; however, longer follow-up is needed and more patients must be studied.
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Affiliation(s)
- Joyce G R Bomers
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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Song SE, Tokuda J, Tuncali K, Tempany CM, Zhang E, Hata N. Development and preliminary evaluation of a motorized needle guide template for MRI-guided targeted prostate biopsy. IEEE Trans Biomed Eng 2013; 60:3019-27. [PMID: 23335658 DOI: 10.1109/tbme.2013.2240301] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To overcome the problems of limited needle insertion accuracy and human error in the use of a conventional needle guide template in magnetic resonance imaging (MRI)-guided prostate intervention, we developed a motorized MRI-compatible needle guide template that resembles a transrectal ultrasound-guided prostate template. The motorized template allows automated, gapless needle guidance in a 3T MRI scanner with minimal changes in the current clinical procedure. To evaluate the impact of the motorized template on MRI, signal-to-noise ratio and distortion were measured under various system configurations. A maximum of 44% signal-to-noise ratio decrease was found when the ultrasonic motors were running, and a maximum of 0.4% image distortion was observed due to the presence of the motorized template. To measure needle insertion accuracy, we performed four sets of five random target needle insertions mimicking four biopsy procedures, which resulted in an average in-plane targeting error of 0.94 mm with a standard deviation of 0.34 mm. The evaluation studies indicated that the presence and operation of the motorized template in the MRI bore create insignificant image degradation, and provide submillimeter targeting accuracy. The automated needle guide that is directly controlled by navigation software eliminates human error so that the safety of the procedure can be improved.
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Fiard G, Descotes JL, Rambeaud JJ, Hohn N, Troccaz J, Long JA. Biopsies prostatiques ciblées guidées par IRM dans le diagnostic du cancer de prostate : revue de la littérature. Prog Urol 2012; 22:903-12. [DOI: 10.1016/j.purol.2012.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 04/13/2012] [Accepted: 06/06/2012] [Indexed: 12/01/2022]
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Richard HM, McMillan A, Staats PN, d'Othee BJ. Real-time MR Imaging Guidance for Percutaneous Core Biopsy of US- and CT-negative Lesion. J Vasc Interv Radiol 2012; 23:1539-42. [DOI: 10.1016/j.jvir.2012.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 11/26/2022] Open
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Tokuda J, Tuncali K, Iordachita I, Song SE, Fedorov A, Oguro S, Lasso A, Fennessy FM, Tempany CM, Hata N. In-bore setup and software for 3T MRI-guided transperineal prostate biopsy. Phys Med Biol 2012; 57:5823-40. [PMID: 22951350 DOI: 10.1088/0031-9155/57/18/5823] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
MRI-guided prostate biopsy in conventional closed-bore scanners requires transferring the patient outside the bore during needle insertion due to the constrained in-bore space, causing a safety hazard and limiting image feedback. To address this issue, we present our custom-made in-bore setup and software to support MRI-guided transperineal prostate biopsy in a wide-bore 3 T MRI scanner. The setup consists of a specially designed tabletop and a needle-guiding template with a Z-frame that gives a physician access to the perineum of the patient at the imaging position and allows the physician to perform MRI-guided transperineal biopsy without moving the patient out of the scanner. The software and Z-frame allow registration of the template, target planning and biopsy guidance. Initially, we performed phantom experiments to assess the accuracy of template registration and needle placement in a controlled environment. Subsequently, we embarked on our clinical trial (N = 10). The phantom experiments showed that the translational errors of the template registration along the right-left (RP) and anterior-posterior (AP) axes were 1.1 ± 0.8 and 1.4 ± 1.1 mm, respectively, while the rotational errors around the RL, AP and superior-inferior axes were (0.8 ± 1.0)°, (1.7 ± 1.6)° and (0.0 ± 0.0)°, respectively. The 2D root-mean-square (RMS) needle-placement error was 3 mm. The clinical biopsy procedures were safely carried out in all ten clinical cases with a needle-placement error of 5.4 mm (2D RMS). In conclusion, transperineal prostate biopsy in a wide-bore 3T scanner is feasible using our custom-made tabletop setup and software, which supports manual needle placement without moving the patient out of the magnet.
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Affiliation(s)
- Junichi Tokuda
- Department of Radiology, Brigham and Womens Hospital and Harvard Medical School, Boston, MA, USA.
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