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Matsui Y, Kamegawa T, Tomita K, Uka M, Umakoshi N, Kawabata T, Munetomo K, Iguchi T, Matsuno T, Hiraki T. Robotic systems in interventional oncology: a narrative review of the current status. Int J Clin Oncol 2024; 29:81-88. [PMID: 37115426 DOI: 10.1007/s10147-023-02344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Interventional oncology offers minimally invasive treatments for malignant tumors for curative and palliative purposes based on the percutaneous insertion of needles or catheters into the target location under image guidance. Robotic systems have been gaining increasing attention as tools that provide potential advantages for image-guided interventions. Among the robotic systems developed for intervention, those relevant to the oncology field are mainly those for guiding or driving the needles in non-vascular interventional procedures such as biopsy and tumor ablation. Needle-guiding robots support planning the needle path and align the needle robotically according to the planned trajectory, which is combined with subsequent manual needle insertion by the physician through the needle guide. Needle-driving robots can advance the needle robotically after determining its orientation. Although a wide variety of robotic systems have been developed, only a limited number of these systems have reached the clinical phase or commercialization thus far. The results of previous studies suggest that such interventional robots have the potential to increase the accuracy of needle placement, facilitate out-of-plane needle insertion, decrease the learning curve, and reduce radiation exposure. On the other hand, increased complexity and costs may be a concern when using robotic systems compared with conventional manual procedures. Further data should be collected to comprehensively assess the value of robotic systems in interventional oncology.
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Affiliation(s)
- Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Tetsushi Kamegawa
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Okayama, Japan
| | - Takayuki Matsuno
- Faculty of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
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2
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Charalampopoulos G, Bale R, Filippiadis D, Odisio BC, Wood B, Solbiati L. Navigation and Robotics in Interventional Oncology: Current Status and Future Roadmap. Diagnostics (Basel) 2023; 14:98. [PMID: 38201407 PMCID: PMC10795729 DOI: 10.3390/diagnostics14010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Interventional oncology (IO) is the field of Interventional Radiology that provides minimally invasive procedures under imaging guidance for the diagnosis and treatment of malignant tumors. Sophisticated devices can be utilized to increase standardization, accuracy, outcomes, and "repeatability" in performing percutaneous Interventional Oncology techniques. These technologies can reduce variability, reduce human error, and outperform human hand-to-eye coordination and spatial relations, thus potentially normalizing an otherwise broad diversity of IO techniques, impacting simulation, training, navigation, outcomes, and performance, as well as verification of desired minimum ablation margin or other measures of successful procedures. Stereotactic navigation and robotic systems may yield specific advantages, such as the potential to reduce procedure duration and ionizing radiation exposure during the procedure and, at the same time, increase accuracy. Enhanced accuracy, in turn, is linked to improved outcomes in many clinical scenarios. The present review focuses on the current role of percutaneous navigation systems and robotics in diagnostic and therapeutic Interventional Oncology procedures. The currently available alternatives are presented, including their potential impact on clinical practice as reflected in the peer-reviewed medical literature. A review of such data may inform wiser investment of time and resources toward the most impactful IR/IO applications of robotics and navigation to both standardize and address unmet clinical needs.
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Affiliation(s)
- Georgios Charalampopoulos
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bradford Wood
- Interventional Radiology and Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Luigi Solbiati
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano (Milano), Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milano), 20072 Milano, Italy;
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Najafi G, Kreiser K, Abdelaziz MEMK, Hamady MS. Current State of Robotics in Interventional Radiology. Cardiovasc Intervent Radiol 2023; 46:549-561. [PMID: 37002481 PMCID: PMC10156773 DOI: 10.1007/s00270-023-03421-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/11/2023] [Indexed: 05/04/2023]
Abstract
As a relatively new specialty with a minimally invasive nature, the field of interventional radiology is rapidly growing. Although the application of robotic systems in this field shows great promise, such as with increased precision, accuracy, and safety, as well as reduced radiation dose and potential for teleoperated procedures, the progression of these technologies has been slow. This is partly due to the complex equipment with complicated setup procedures, the disruption to theatre flow, the high costs, as well as some device limitations, such as lack of haptic feedback. To further assess these robotic technologies, more evidence of their performance and cost-effectiveness is needed before their widespread adoption within the field. In this review, we summarise the current progress of robotic systems that have been investigated for use in vascular and non-vascular interventions.
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Affiliation(s)
- Ghazal Najafi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK.
| | - Kornelia Kreiser
- Department of Neuroradiology, Rehabilitations - und Universitätskliniken Ulm, 89081, Ulm, Germany
| | - Mohamed E M K Abdelaziz
- The Hamlyn Centre, Imperial College London, London, SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Mohamad S Hamady
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
- The Hamlyn Centre, Imperial College London, London, SW7 2AZ, UK
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4
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Moreira P, Grimble J, Bernardes MC, Iftimia N, Levesque VM, Foley L, Tuncali K, Tokuda J, Park J. Motorized template for MRI-guided focal cryoablation of prostate cancer. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2023; 5:335-342. [PMID: 37312886 PMCID: PMC10259684 DOI: 10.1109/tmrb.2023.3272025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
MR-guided focal cryoablation of prostate cancer has often been selected as a minimally-invasive treatment option. Placing multiple cryo-needles accurately to form an ablation volume that adequately covers the target volume is crucial for better oncological/functional outcomes. This paper presents an MRI-compatible system combining a motorized tilting grid template with insertion depth sensing capabilities, enabling the physician to precisely place the cryo-needles into the desired location. In vivo animal study in a swine model (3 animals) was performed to test the device performance including targeting accuracy and the procedure workflow. The study showed that the insertion depth feedback improved the 3D targeting accuracy when compared to the conventional insertion technique (7.4 mm vs. 11.2 mm, p=0.04). All three cases achieved full iceball coverage without repositioning the cryo-needles. The results demonstrate the advantages of the motorized tilting mechanism and real-time insertion depth feedback, as well as the feasibility of the proposed workflow for MRI-guided focal cryoablation of prostate cancer.
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Affiliation(s)
- Pedro Moreira
- Department of Radiology at the Brigham and Women's Hospital and Harvard Medical School., Boston 02138 MA, USA
| | | | - Mariana C Bernardes
- Department of Radiology at the Brigham and Women's Hospital and Harvard Medical School., Boston 02138 MA, USA
| | | | - Vincent M Levesque
- Department of Radiology at the Brigham and Women's Hospital and Harvard Medical School., Boston 02138 MA, USA
| | - Lori Foley
- Department of Radiology at the Brigham and Women's Hospital and Harvard Medical School., Boston 02138 MA, USA
| | - Kemal Tuncali
- Department of Radiology at the Brigham and Women's Hospital and Harvard Medical School., Boston 02138 MA, USA
| | - Junichi Tokuda
- Department of Radiology at the Brigham and Women's Hospital and Harvard Medical School., Boston 02138 MA, USA
| | - Jesung Park
- Physical Science Inc., Andover 01810 MA, USA
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5
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Park JJ, Kim CK. Paradigm Shift in Prostate Cancer Diagnosis: Pre-Biopsy Prostate Magnetic Resonance Imaging and Targeted Biopsy. Korean J Radiol 2022; 23:625-637. [PMID: 35555886 PMCID: PMC9174506 DOI: 10.3348/kjr.2022.0059] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 12/24/2022] Open
Abstract
With regard to the indolent clinical characteristics of prostate cancer (PCa), the more selective detection of clinically significant PCa (CSC) has been emphasized in its diagnosis and management. Magnetic resonance imaging (MRI) has advanced technically, and recent international cooperation has provided a standardized imaging and reporting system for prostate MRI. Accordingly, prostate MRI has recently been investigated and utilized as a triage tool before biopsy to guide tissue sampling to increase the detection rate of CSC beyond the staging tool for patients in whom PCa was already confirmed on conventional systematic biopsy. Radiologists must understand the current paradigm shift for better PCa diagnosis and management. This article reviewed the recent literature, demonstrating the diagnostic value of pre-biopsy prostate MRI with targeted biopsy and discussed unsolved issues regarding the paradigm shift in the diagnosis of PCa.
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Affiliation(s)
- Jung Jae Park
- Department of Radiology, Chungnam National University Hospital, Daejeon, Korea.,Department of Radiology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.
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6
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Li G, Patel NA, Melzer A, Sharma K, Iordachita I, Cleary K. MRI-guided lumbar spinal injections with body-mounted robotic system: cadaver studies. MINIM INVASIV THER 2022; 31:297-305. [PMID: 32729771 PMCID: PMC7855543 DOI: 10.1080/13645706.2020.1799017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This paper reports the system integration and cadaveric assessment of a body-mounted robotic system for MRI-guided lumbar spine injections. The system is developed to enable MR-guided interventions in closed bore magnet and avoid problems due to patient movement during cannula guidance. MATERIAL AND METHODS The robot is comprised by a lightweight and compact structure so that it can be mounted directly onto the lower back of a patient using straps. Therefore, it can minimize the influence of patient movement by moving with the patient. The MR-Conditional robot is integrated with an image-guided surgical planning workstation. A dedicated clinical workflow is created for the robot-assisted procedure to improve the conventional freehand MRI-guided procedure. RESULTS Cadaver studies were performed with both freehand and robot-assisted approaches to validate the feasibility of the clinical workflow and to assess the positioning accuracy of the robotic system. The experiment results demonstrate that the root mean square (RMS) error of the target position to be 2.57 ± 1.09 mm and of the insertion angle to be 2.17 ± 0.89°. CONCLUSION The robot-assisted approach is able to provide more accurate and reproducible cannula placements than the freehand procedure, as well as to reduce the number of insertion attempts.
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Affiliation(s)
- Gang Li
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, USA;,Gang Li, , 3400 N. Charles St., Baltimore, MD 21218, USA
| | - Niravkumar A. Patel
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, USA
| | - Andreas Melzer
- Institute of Medical Science and Technology, University of Dundee, Dundee, UK
| | - Karun Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, USA
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Moreira P, Grimble J, Iftimia N, Bay CP, Tuncali K, Park J, Tokuda J. In vivo evaluation of angulated needle-guide template for MRI-guided transperineal prostate biopsy. Med Phys 2021; 48:2553-2565. [PMID: 33651407 DOI: 10.1002/mp.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI)-guided transperineal prostate biopsy has been practiced since the early 2000s. The technique often suffers from targeting error due to deviation of the needle as a result of physical interaction between the needle and inhomogeneous tissues. Existing needle guide devices, such as a grid template, do not allow choosing an alternative insertion path to mitigate the deviation because of their limited degree-of-freedom (DoF). This study evaluates how an angulated needle insertion path can reduce needle deviation and improve needle placement accuracy. METHODS We extended a robotic needle-guidance device (Smart Template) for in-bore MRI-guided transperineal prostate biopsy. The new Smart Template has a 4-DoF needle-guiding mechanism allowing a translational range of motion of 65 and 58 mm along the vertical and horizontal axis, and a needle rotational motion around the vertical and horizontal axis ± 30 ∘ and a vertical rotational range of - 30 ∘ , + 10 ∘ , respectively. We defined a path planning strategy, which chooses between straight and angulated insertion paths depending on the anatomical structures on the potential insertion path. We performed (a) a set of experiments to evaluate the device positioning accuracy outside the MR-bore, and (b) an in vivo experiment to evaluate the improvement of targeting accuracy combining straight and angulated insertions in animal models (swine, n = 3 ). RESULTS We analyzed 46 in vivo insertions using either straight or angulated insertions paths. The experiment showed that the proposed strategy of selecting straight or angulated insertions based on the subject's anatomy outperformed the conventional approach of just straight insertions in terms of targeting accuracy (2.4 mm [1.3-3.7] vs 3.9 mm [2.4-5.0] {Median IQR } ); p = 0.041 after the bias correction). CONCLUSION The in vivo experiment successfully demonstrated that an angulated needle insertion path could improve needle placement accuracy with a path planning strategy that takes account of the subject-specific anatomical structures.
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Affiliation(s)
- Pedro Moreira
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - John Grimble
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Nicusor Iftimia
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Jesung Park
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
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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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9
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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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10
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Pan L, Valdeig S, Kägebein U, Qing K, Fetics B, Roth A, Nevo E, Hensen B, Weiss CR, Wacker FK. Integration and evaluation of a gradient-based needle navigation system for percutaneous MR-guided interventions. PLoS One 2020; 15:e0236295. [PMID: 32706813 PMCID: PMC7380643 DOI: 10.1371/journal.pone.0236295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
The purpose of the present study was to integrate an interactive gradient-based needle navigation system and to evaluate the feasibility and accuracy of the system for real-time MR guided needle puncture in a multi-ring phantom and in vivo in a porcine model. The gradient-based navigation system was implemented in a 1.5T MRI. An interactive multi-slice real-time sequence was modified to provide the excitation gradients used by two sets of three orthogonal pick-up coils integrated into a needle holder. Position and orientation of the needle holder were determined and the trajectory was superimposed on pre-acquired MR images. A gel phantom with embedded ring targets was used to evaluate accuracy using 3D distance from needle tip to target. Six punctures were performed in animals to evaluate feasibility, time, overall error (target to needle tip) and system error (needle tip to the guidance needle trajectory) in vivo. In the phantom experiments, the overall error was 6.2±2.9 mm (mean±SD) and 4.4±1.3 mm, respectively. In the porcine model, the setup time ranged from 176 to 204 seconds, the average needle insertion time was 96.3±40.5 seconds (min: 42 seconds; max: 154 seconds). The overall error and the system error was 8.8±7.8 mm (min: 0.8 mm; max: 20.0 mm) and 3.3±1.4 mm (min: 1.8 mm; max: 5.2 mm), respectively.
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Affiliation(s)
- Li Pan
- Siemens Healthineers, Baltimore, MD, United States of America
| | - Steffi Valdeig
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, United States of America
| | - Urte Kägebein
- Department of Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE–Research Campus: Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
| | - Kun Qing
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States of America
- Siemens Corporate Technology, Baltimore, MD, United States of America
| | - Barry Fetics
- Robin Medical Inc., Baltimore, MD, United States of America
| | - Amir Roth
- Robin Medical Inc., Baltimore, MD, United States of America
| | - Erez Nevo
- Robin Medical Inc., Baltimore, MD, United States of America
| | - Bennet Hensen
- Department of Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE–Research Campus: Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
- * E-mail:
| | - Clifford R. Weiss
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, United States of America
| | - Frank K. Wacker
- Department of Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE–Research Campus: Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
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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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12
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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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13
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Warlick C, Futterer J, Maruf M, George AK, Rastinehad AR, Pinto PA, Bosaily AES, Villers A, Moore CM, Mendhiratta N, Taneja SS, Ukimura O, Konety BR. Beyond transrectal ultrasound-guided prostate biopsies: available techniques and approaches. World J Urol 2018; 37:419-427. [PMID: 29943220 DOI: 10.1007/s00345-018-2374-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/08/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Recent advances have led to the use of magnetic resonance imaging (MRI) alone or with fusion to transrectal ultrasound (TRUS) images for guiding biopsy of the prostate. Our group sought to develop consensus recommendations regarding MRI-guided prostate biopsy based on currently available literature and expert opinion. METHODS The published literature on the subject of MRI-guided prostate biopsy was reviewed using standard search terms and synthesized and analyzed by four different subgroups from among the authors. The literature was grouped into four categories-MRI-guided biopsy platforms, robotic MRI-TRUS fusion biopsy, template mapping biopsy and transrectal MRI-TRUS fusion biopsy. Consensus recommendations were developed using the Oxford Center for Evidence Based Medicine criteria. RESULTS There is limited high level evidence available on the subject of MRI-guided prostate biopsy. MRI guidance with or without TRUS fusion can lead to fewer unnecessary biopsies, help identify high-risk (Gleason ≥ 3 + 4) cancers that might have been missed on standard TRUS biopsy and identify cancers in the anterior prostate. There is no apparent significant difference between MRI biopsy platforms. Template mapping biopsy is perhaps the most accurate method of assessing volume and grade of tumor but is accompanied by higher incidence of side effects compared to TRUS biopsy. CONCLUSIONS Magnetic resonance imaging-guided biopsies are feasible and better than traditional ultrasound-guided biopsies for detecting high-risk prostate cancer and anterior lesions. Judicious use of MRI-guided biopsy could enhance diagnosis of clinically significant prostate cancer while limiting diagnosis of insignificant cancer.
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Affiliation(s)
| | - Jurgen Futterer
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | | | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Ahmed El-Shater Bosaily
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Arnauld Villers
- Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Neil Mendhiratta
- School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Samir S Taneja
- School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Osamu Ukimura
- Department of Urology, University of Southern California, Los Angeles, CA, USA
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Hiraki T, Matsuno T, Kamegawa T, Komaki T, Sakurai J, Matsuura R, Yamaguchi T, Sasaki T, Iguchi T, Matsui Y, Gobara H, Kanazawa S. Robotic Insertion of Various Ablation Needles Under Computed Tomography Guidance: Accuracy in Animal Experiments. Eur J Radiol 2018; 105:162-167. [PMID: 30017274 DOI: 10.1016/j.ejrad.2018.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the accuracy of robotic insertion of various ablation needles at various locations under computed tomography (CT) guidance in swine. MATERIALS AND METHODS The robot was used for CT-guided insertion of four ablation needles, namely a single internally cooled radiofrequency ablation (RFA) needle (Cool-tip), a multi-tined expandable RFA needle (LeVeen), a cryoablation needle (IceRod), and an internally cooled microwave ablation needle (Emprint). One author remotely operated the robot with the operation interface in order to orient and insert the needles under CT guidance. Five insertions of each type of ablation needle towards 1.0-mm targets in the liver, kidney, lung, and hip muscle were attempted on the plane of an axial CT image in six swine. Accuracy of needle insertion was evaluated as the three-dimensional length between the target centre and needle tip. The accuracy of needle insertion was compared according to the type of needle used and the location using one-way analysis of variance. RESULTS The overall mean accuracy of all four needles in all four locations was 2.8 mm. The mean accuracy of insertion of the Cool-tip needle, LeVeen needle, IceRod needle, and Emprint needle was 2.8 mm, 3.1 mm, 2.5 mm, and 2.7 mm, respectively. The mean accuracy of insertion into the liver, kidney, lung, and hip muscle was 2.7 mm, 2.9 mm, 2.9 mm, and 2.5 mm, respectively. There was no significant difference in insertion accuracy among the needles (P = .38) or the locations (P = .53). CONCLUSION Robotic insertion of various ablation needles under CT guidance was accurate regardless of type of needle or location in swine.
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Affiliation(s)
- Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Takayuki Matsuno
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsusimanaka, Kitaku, Okayama 700-8530, Japan
| | - Tetsushi Kamegawa
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, 3-1-1 Tsusimanaka, Kitaku, Okayama 700-8530, Japan
| | - Toshiyuki Komaki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Ryutaro Matsuura
- Graduate School of Health Sciences, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takuya Yamaguchi
- Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takanori Sasaki
- Collaborative Research Center for OMIC, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Hideo Gobara
- Division of Medical Informatics, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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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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16
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Feasibility study of MR-guided transgluteal targeted in-bore biopsy for suspicious lesions of the prostate at 3 Tesla using a freehand approach. Eur Radiol 2018; 28:2690-2699. [DOI: 10.1007/s00330-017-5187-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 11/26/2022]
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17
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Hiraki T, Kamegawa T, Matsuno T, Sakurai J, Kirita Y, Matsuura R, Yamaguchi T, Sasaki T, Mitsuhashi T, Komaki T, Masaoka Y, Matsui Y, Fujiwara H, Iguchi T, Gobara H, Kanazawa S. Robotically Driven CT-guided Needle Insertion: Preliminary Results in Phantom and Animal Experiments. Radiology 2017; 285:454-461. [DOI: 10.1148/radiol.2017162856] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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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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Zhu JH, Wang J, Wang YG, Li M, Guo YX, Liu XJ, Guo CB. Performance of Robotic Assistance for Skull Base Biopsy: A Phantom Study. J Neurol Surg B Skull Base 2017; 78:385-392. [PMID: 28875116 DOI: 10.1055/s-0037-1602791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/21/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives This study aims to evaluate the feasibility of a custom robot system guided by optical cone beam computed tomography (CBCT)-based navigation for skull base biopsy. Design An accuracy study was conducted. Setting Platform for navigation and robot-aided surgery technology. Participants Phantom skull. Main Outcome Measures The primary outcome measure was to investigate the accuracy of robot-assisted needle biopsy for skull base tumors. A 14-gauge needle was automatically inserted by the five degrees of freedom robot into the intended target, guided by optical navigation. The result was displayed on the graphical user interface after matrix transformation. Postoperative image scanning was performed, and the result was verified with image fusion. Results All 20 interventions were successfully performed. The mean deviation of the needle tip was 0.56 ± 0.22 mm (measured by the navigation system) versus 1.73 ± 0.60 mm (measured by image fusion) ( p < 0.05). The mean insertion depth was 52.3 mm (range: 49.7-55.2 mm). The mean angular deviations off the x-axis, y-axis, and z-axis were 1.51 ± 0.67, 2.33 ± 1.65, and 1.47 ± 1.16 degrees, respectively. Conclusions The experimental results show the robot system is efficient, reliable, and safe. The navigation accuracy is a significant factor in robotic procedures.
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Affiliation(s)
- Jian-Hua Zhu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
| | - Jing Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
| | - Yong-Gui Wang
- Intelligent Robotics Institute, Beijing Institute of Technology, Haidian District, Beijing, People's Republic of China
| | - Meng Li
- Intelligent Robotics Institute, Beijing Institute of Technology, Haidian District, Beijing, People's Republic of China
| | - Yu-Xing Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
| | - Xiao-Jing Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
| | - Chuan-Bin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, People's Republic of China
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Dou H, Jiang S, Yang Z, Sun L, Ma X, Huo B. Design and validation of a CT-guided robotic system for lung cancer brachytherapy. Med Phys 2017; 44:4828-4837. [PMID: 28657112 DOI: 10.1002/mp.12435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Currently, lung brachytherapy in clinical setting is a complex procedure. Operation accuracy depends on accurate positioning of the template; however, it is difficult to guarantee the positioning accuracy manually. Application of robotic-assisted systems can simplify the procedure and improve the manual positioning accuracy. Therefore, a novel CT-guided robotic system was developed to assist the lung cancer brachytherapy. METHODS A four degree-of-freedom (DOF) robot, controlled by a lung brachytherapy treatment planning system (TPS) software, was designed and manufactured to assist the template positioning. Target position of the template can be obtained from the treatment plan, thus the robot is driven to the target position automatically. The robotic system was validated in both the laboratory and the CT environment. In laboratory environment, a 3D laser tracker and an inertial measurement unit (IMU) were used to measure the mechanical accuracy in air, which includes positioning accuracy and position repeatability. Working reliability was also validated in this procedure by observing the response reliability and calculating the position repeatability. Imaging artifacts and accuracy of the robot registration were validated in the CT environment by using an artificial phantom with fiducial markers. CT images were obtained and used to test the image artifact and calculate the registration accuracy. Phantom experiments were conducted to test the accuracy of needle insertion by using a transparent hydrogel phantom with a high imitation artificial phantom. Also, the efficiency was validated in this procedure by comparing time costs in manual positioning with robotic positioning under the same experimental conditions. RESULTS The robotic system achieved the positioning accuracy of 0.28 ± 0.25 mm and the position repeatability of 0.09 ± 0.11 mm. Experimental results showed that the robot was CT-compatible and responded reliably to the control commands. The mean registration accuracy of the robotic system was 0.49 ± 0.29 mm. Phantom experiments indicated that the accuracy of needle insertion was 1.5 ± 1.7 mm at a depth ranging from 30 to 80 mm. The time used to adjust the template to the target position was 12 min on average by robotic system automatically. An average of 30 min was saved compared with the manual positioning procedure in phantom experiments. CONCLUSIONS This paper describes the design and experimental validation of a novel CT-guided robotic system for lung cancer brachytherapy. The robotic system was validated in a number of aspects which prove that it was capable of locating the template with clinically acceptable accuracy in the CT environment. All experimental results indicated that the system is reliable and ready to be applied to further studies on animals.
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Affiliation(s)
- Huaisu Dou
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Shan Jiang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China.,Centre for advanced Mechanisms and Robotics, Tianjin University, Tianjin, 300350, China
| | - Zhiyong Yang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Luqing Sun
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Xiaodong Ma
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Bin Huo
- Department of Oncology, The second Hospital of Tianjin Medical University, Tianjin, 300211, China
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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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22
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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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Hungr N, Bricault I, Cinquin P, Fouard C. Design and Validation of a CT- and MRI-Guided Robot for Percutaneous Needle Procedures. IEEE T ROBOT 2016. [DOI: 10.1109/tro.2016.2588884] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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24
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Hoffner MKM, Huebner F, Scholtz JE, Zangos S, Schulz B, Luboldt W, Vogl TJ, Bodelle B. Impact of an endorectal coil for 1H-magnetic resonance spectroscopy of the prostate at 3.0T in comparison to 1.5T: Do we need an endorectal coil? Eur J Radiol 2016; 85:1432-8. [PMID: 27423684 DOI: 10.1016/j.ejrad.2016.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the influence of endorectal coil (ERC) regarding spectral quality and diagnostic suitability and diagnostic performance in 3.0T 1H-magnetic resonance spectroscopy imaging (MRSI) compared to 1.5T MRSI. MATERIALS AND METHODS The study was approved by the Institutional Review Board. MRSI of the prostate was performed on 19 patients at 1.5T with ERC (protocol 1), at 3.0T with a disabled ERC (protocol 2) and at 3.0T with ERC (protocol 3). Age, weight, body size, body-mass-index, prostate volume, time between measurements, diagnostic suitability of spectra, histopathological results after biopsy of cancer suspect lesions (CSL), sensitivity and specificity were evaluated. Signal-to-noise ratio (SNR) was calculated and compared using semiparametrical multiple Conover-comparisons. Correlations between SNR and prostate volume and BMI were indicated using Pearson correlation coefficient. Distribution of SNR was evaluated for prostate quadrants. RESULTS Diagnostic suitable spectra were achieved in 76 % (protocol 1, 100% in CSL), 32 % (protocol 2, 59% in CSL) and 50 % (protocol 3, 80% in CSL) of the voxels. SNR was significantly higher in protocol 3 compared to protocol 2 and 1 (93,729 vs. 27,836 vs. 32,897, p<0.0001) with significant difference between protocol 2 and 1 (p<0.023). Highest SNR was achieved in the dorsal prostate (protocols 1 and 3; p<0.0001). Sensitivity at 3.0T was higher with use of ERC. Specificity was highest at 1.5T with ERC. CONCLUSION The ERC improves the diagnostic suitability and the SNR in MRSI at 3.0T. Less voxels at 3.0T with disabled ERC are suitable for diagnosis compared to 1.5T with ERC. MRSI at 3.0T with ERC shows the highest SNR. SNR in dorsal quadrants of the prostate was higher using ERC.
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Affiliation(s)
- Maximilian K M Hoffner
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Frank Huebner
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Jan Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Stephan Zangos
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Boris Schulz
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Wolfgang Luboldt
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
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Abstract
PURPOSE OF REVIEW This review discusses the feasibility, recent advances and current status of in-bore MRI-guided interventional techniques for diagnosis and treatment of focal prostate cancer (PCa) and also explores the future applications, highlighting the emerging strategies for the treatment of PCa. RECENT FINDINGS Multiparametric MRI has opened up opportunities for diagnosis and targeted therapeutics to the site of disease within the organ wherein minimizing the incidence of treatment-related toxicity of whole gland therapy. MRI-guided targeted biopsy has a higher detection rate for significant cancer and lower rate of detection of insignificant cancer. In comparison to ultrasound-guided focal therapy, in-bore treatment provides the advantage of real time thermal monitoring during treatment and assessment of treatment coverage by an enhanced scan immediately post-treatment. Preliminary results of ongoing phase I and II in-bore focal PCa treatment trials via transperineal, transrectal and transurethral routes, using different energy modalities for the ablation, have shown promising results. SUMMARY Advances in multiparametric-MRI has opened up opportunities for in-bore targeted focal treatment of PCa in the correctly selected patient.
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Targeting Accuracy, Procedure Times and User Experience of 240 Experimental MRI Biopsies Guided by a Clinical Add-On Navigation System. PLoS One 2015. [PMID: 26222443 PMCID: PMC4519044 DOI: 10.1371/journal.pone.0134370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES MRI is of great clinical utility for the guidance of special diagnostic and therapeutic interventions. The majority of such procedures are performed iteratively ("in-and-out") in standard, closed-bore MRI systems with control imaging inside the bore and needle adjustments outside the bore. The fundamental limitations of such an approach have led to the development of various assistance techniques, from simple guidance tools to advanced navigation systems. The purpose of this work was to thoroughly assess the targeting accuracy, workflow and usability of a clinical add-on navigation solution on 240 simulated biopsies by different medical operators. METHODS Navigation relied on a virtual 3D MRI scene with real-time overlay of the optically tracked biopsy needle. Smart reference markers on a freely adjustable arm ensured proper registration. Twenty-four operators - attending (AR) and resident radiologists (RR) as well as medical students (MS) - performed well-controlled biopsies of 10 embedded model targets (mean diameter: 8.5 mm, insertion depths: 17-76 mm). Targeting accuracy, procedure times and 13 Likert scores on system performance were determined (strong agreement: 5.0). RESULTS Differences in diagnostic success rates (AR: 93%, RR: 88%, MS: 81%) were not significant. In contrast, between-group differences in biopsy times (AR: 4:15, RR: 4:40, MS: 5:06 min:sec) differed significantly (p<0.01). Mean overall rating was 4.2. The average operator would use the system again (4.8) and stated that the outcome justifies the extra effort (4.4). Lowest agreement was reported for the robustness against external perturbations (2.8). CONCLUSIONS The described combination of optical tracking technology with an automatic MRI registration appears to be sufficiently accurate for instrument guidance in a standard (closed-bore) MRI environment. High targeting accuracy and usability was demonstrated on a relatively large number of procedures and operators. Between groups with different expertise there were significant differences in experimental procedure times but not in the number of successful biopsies.
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Gruber-Rouh T, Lee C, Bolck J, Naguib NNN, Schulz B, Eichler K, Aschenbach R, Wichmann JL, Vogl TJ, Zangos S. Intervention Planning Using a Laser Navigation System for CT-Guided Interventions: A Phantom and Patient Study. Korean J Radiol 2015; 16:729-35. [PMID: 26175571 PMCID: PMC4499536 DOI: 10.3348/kjr.2015.16.4.729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 05/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the accuracy, efficiency and radiation dose of a novel laser navigation system (LNS) compared to those of free-handed punctures on computed tomography (CT). Materials and Methods Sixty punctures were performed using a phantom body to compare accuracy, timely effort, and radiation dose of the conventional free-handed procedure to those of the LNS-guided method. An additional 20 LNS-guided interventions were performed on another phantom to confirm accuracy. Ten patients subsequently underwent LNS-guided punctures. Results The phantom 1-LNS group showed a target point accuracy of 4.0 ± 2.7 mm (freehand, 6.3 ± 3.6 mm; p = 0.008), entrance point accuracy of 0.8 ± 0.6 mm (freehand, 6.1 ± 4.7 mm), needle angulation accuracy of 1.3 ± 0.9° (freehand, 3.4 ± 3.1°; p < 0.001), intervention time of 7.03 ± 5.18 minutes (freehand, 8.38 ± 4.09 minutes; p = 0.006), and 4.2 ± 3.6 CT images (freehand, 7.9 ± 5.1; p < 0.001). These results show significant improvement in 60 punctures compared to freehand. The phantom 2-LNS group showed a target point accuracy of 3.6 ± 2.5 mm, entrance point accuracy of 1.4 ± 2.0 mm, needle angulation accuracy of 1.0 ± 1.2°, intervention time of 1.44 ± 0.22 minutes, and 3.4 ± 1.7 CT images. The LNS group achieved target point accuracy of 5.0 ± 1.2 mm, entrance point accuracy of 2.0 ± 1.5 mm, needle angulation accuracy of 1.5 ± 0.3°, intervention time of 12.08 ± 3.07 minutes, and used 5.7 ± 1.6 CT-images for the first experience with patients. Conclusion Laser navigation system improved accuracy, duration of intervention, and radiation dose of CT-guided interventions.
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Affiliation(s)
- Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Clara Lee
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Jan Bolck
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Nagy N N Naguib
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany. ; Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria 21514, Egypt
| | - Boris Schulz
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Rene Aschenbach
- Department of Radiology, HELIOS Klinikum Erfurt, Erfurt 99089, Germany
| | - Julian L Wichmann
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Stephan Zangos
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
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Abstract
Recent advances in multiparametric magnetic resonance imaging (mp-MRI) have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa). Its sensitivity in detecting clinically significant cancer and the ability to localize the tumor within the prostate gland has opened up discussion on targeted diagnosis and therapy in PCa. Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS) biopsy and improves the diagnosis of PCa. Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa. This review discusses the evidence and techniques for in-bore MRI-guided prostate biopsy and provides an update on the status of MRI-guided targeted focal therapy in PCa.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - John Trachtenberg
- Prostate Centre, Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
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Nassiri N, Natarajan S, Margolis DJ, Marks LS. Targeted Prostate Biopsy: Lessons Learned Midst the Evolution of a Disruptive Technology. Urology 2015; 86:432-8. [PMID: 26166671 DOI: 10.1016/j.urology.2015.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 05/26/2015] [Accepted: 07/07/2015] [Indexed: 12/24/2022]
Abstract
Lessons learned during a 6-year experience with more than 1200 patients undergoing targeted prostate biopsy via MRI/ultrasound fusion are reported: (1) the procedure is safe and efficient, requiring some 15-20 minutes in an office setting; (2) MRI is best performed by a radiologist with specialized training, using a transabdominal multiparametric approach and preferably a 3T magnet; (3) grade of MRI suspicion is the most powerful predictor of biopsy results, eg, Grade 5 usually represents cancer; (4) some potentially important cancers (15%-30%) are MRI-invisible; (5) Targeted biopsies provide >80% concordance with whole-organ pathology. Early enthusiasm notwithstanding, cost-effectiveness is yet to be resolved, and the technologies remain in evolution.
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Affiliation(s)
- Nima Nassiri
- Department of Urology, University of California at Los Angeles, Los Angeles, CA
| | - Shyam Natarajan
- Department of Urology, University of California at Los Angeles, Los Angeles, CA; Departments of Urology and Biomedical Engineering, University of California at Los Angeles, Los Angeles, CA
| | - Daniel J Margolis
- Department of Radiology, University of California at Los Angeles, Los Angeles, CA
| | - Leonard S Marks
- Department of Urology, University of California at Los Angeles, Los Angeles, CA.
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30
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Yoo S, Kim JK, Jeong IG. Multiparametric magnetic resonance imaging for prostate cancer: A review and update for urologists. Korean J Urol 2015; 56:487-97. [PMID: 26175867 PMCID: PMC4500805 DOI: 10.4111/kju.2015.56.7.487] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022] Open
Abstract
Recently, imaging of prostate cancer has greatly advanced since the introduction of multiparametric magnetic resonance imaging (mpMRI). mpMRI consists of T2-weighted sequences combined with several functional sequences including diffusion-weighted imaging, dynamic contrast-enhanced imaging, and/or magnetic resonance spectroscopy imaging. Interest has been growing in mpMRI because no single MRI sequence adequately detects and characterizes prostate cancer. During the last decade, the role of mpMRI has been expanded in prostate cancer detection, staging, and targeting or guiding prostate biopsy. Recently, mpMRI has been used to assess prostate cancer aggressiveness and to identify anteriorly located tumors before and during active surveillance. Moreover, recent studies have reported that mpMRI is a reliable imaging modality for detecting local recurrence after radical prostatectomy or external beam radiation therapy. In this regard, some urologic clinical practice guidelines recommended the use of mpMRI in the diagnosis and management of prostate cancer. Because mpMRI is the evolving reference standard imaging modality for prostate cancer, urologists should acquire cutting-edge knowledge about mpMRI. In this article, we review the literature on the use of mpMRI in urologic practice and provide a brief description of techniques. More specifically, we state the role of mpMRI in prostate biopsy, active surveillance, high-risk prostate cancer, and detection of recurrence after radical prostatectomy.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Kon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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31
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Kettenbach J, Kronreif G. Robotic systems for percutaneous needle-guided interventions. MINIM INVASIV THER 2014; 24:45-53. [DOI: 10.3109/13645706.2014.977299] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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32
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Cornelis F, Takaki H, Laskhmanan M, Durack JC, Erinjeri JP, Getrajdman GI, Maybody M, Sofocleous CT, Solomon SB, Srimathveeravalli G. Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver. Cardiovasc Intervent Radiol 2014; 38:1252-60. [PMID: 25376924 DOI: 10.1007/s00270-014-1016-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/08/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare CT fluoroscopy-guided manual and CT-guided robotic positioning system (RPS)-assisted needle placement by experienced IR physicians to targets in swine liver. MATERIALS AND METHODS Manual and RPS-assisted needle placement was performed by six experienced IR physicians to four 5 mm fiducial seeds placed in swine liver (n = 6). Placement performance was assessed for placement accuracy, procedure time, number of confirmatory scans, needle manipulations, and procedure radiation dose. Intra-modality difference in performance for each physician was assessed using paired t test. Inter-physician performance variation for each modality was analyzed using Kruskal-Wallis test. RESULTS Paired comparison of manual and RPS-assisted placements to a target by the same physician indicated accuracy outcomes was not statistically different (manual: 4.53 mm; RPS: 4.66 mm; p = 0.41), but manual placement resulted in higher total radiation dose (manual: 1075.77 mGy/cm; RPS: 636.4 mGy/cm; p = 0.03), required more confirmation scans (manual: 6.6; RPS: 1.6; p < 0.0001) and needle manipulations (manual: 4.6; RPS: 0.4; p < 0.0001). Procedure time for RPS was longer than manual placement (manual: 6.12 min; RPS: 9.7 min; p = 0.0003). Comparison of inter-physician performance during manual placement indicated significant differences in the time taken to complete placements (p = 0.008) and number of repositions (p = 0.04) but not in other study measures (p > 0.05). Comparison of inter-physician performance during RPS-assisted placement suggested statistically significant differences in procedure time (p = 0.02) and not in other study measures (p > 0.05). CONCLUSIONS CT-guided RPS-assisted needle placement reduced radiation dose, number of confirmatory scans, and needle manipulations when compared to manual needle placement by experienced IR physicians, with equivalent accuracy.
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Affiliation(s)
- F Cornelis
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - H Takaki
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - M Laskhmanan
- Perfint Healthcare Inc, Chennai, Tamil Nadu, India
| | - J C Durack
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - J P Erinjeri
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - G I Getrajdman
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - M Maybody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - C T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - S B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - G Srimathveeravalli
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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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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Rais-Bahrami S, Turkbey B, Grant KB, Pinto PA, Choyke PL. Role of multiparametric magnetic resonance imaging in the diagnosis of prostate cancer. Curr Urol Rep 2014; 15:387. [PMID: 24430169 DOI: 10.1007/s11934-013-0387-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Prostate cancer is the most common solid-organ malignancy among American men. It is currently most commonly diagnosed on random systematic biopsies prompted by elevated serum PSA levels. Multi-parametric MRI (MP-MRI) of the prostate has emerged as an anatomic and functional imaging modality, which offers accurate detection, localization and staging of prostate cancer. Recently, MP-MRI has gained an increasing role in guiding biopsies to sites of abnormality and in monitoring patients on active surveillance. Here, we discuss the historical development, current role, and potential future directions of MP-MRI in the diagnosis of prostate cancer.
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Affiliation(s)
- Soroush Rais-Bahrami
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10 - CRC, Bethesda, MD, 20892, USA
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35
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Zamecnik P, Schouten MG, Krafft AJ, Maier F, Schlemmer HP, Barentsz JO, Bock M, Fütterer JJ. Automated real-time needle-guide tracking for fast 3-T MR-guided transrectal prostate biopsy: a feasibility study. Radiology 2014; 273:879-86. [PMID: 25061830 DOI: 10.1148/radiol.14132067] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the feasibility of automatic needle-guide tracking by using a real-time phase-only cross correlation ( POCC phase-only cross correlation ) algorithm-based sequence for transrectal 3-T in-bore magnetic resonance (MR)-guided prostate biopsies. MATERIALS AND METHODS This study was approved by the ethics review board, and written informed consent was obtained from all patients. Eleven patients with a prostate-specific antigen level of at least 4 ng/mL (4 μg/L) and at least one transrectal ultrasonography-guided biopsy session with negative findings were enrolled. Regions suspicious for cancer were identified on 3-T multiparametric MR images. During a subsequent MR-guided biopsy, the regions suspicious for cancer were reidentified and targeted by using the POCC phase-only cross correlation -based tracking sequence. Besides testing a general technical feasibility of the biopsy procedure by using the POCC phase-only cross correlation -based tracking sequence, the procedure times were measured, and a pathologic analysis of the biopsy cores was performed. RESULTS Thirty-eight core samples were obtained from 25 regions suspicious for cancer. It was technically feasible to perform the POCC phase-only cross correlation -based biopsies in all regions suspicious for cancer in each patient, with adequate biopsy samples obtained with each biopsy attempt. The median size of the region suspicious for cancer was 8 mm (range, 4-13 mm). In each region suspicious for cancer (median number per patient, two; range, 1-4), a median of one core sample per region was obtained (range, 1-3). The median time for guidance per target was 1.5 minutes (range, 0.7-5 minutes). Nineteen of 38 core biopsy samples contained cancer. CONCLUSION This study shows that it is feasible to perform transrectal 3-T MR-guided biopsies by using a POCC phase-only cross correlation algorithm-based real-time tracking sequence.
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Affiliation(s)
- Patrik Zamecnik
- From the Department of Radiology, St Radboud University Nijmegen Medical Center, UMC St Radboud, Internal Post Code 766, Postbus 9101, Geert Grooteplein 10, 6500 HB Nijmegen, the Netherlands (P.Z., M.G.S., J.O.B., J.J.F.); Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, Tenn (A.J.K.); Department of Imaging Physics, University of Texas-MD Anderson Cancer Center, Houston, Tex (F.M.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (H.P.S.); Department of Radiology, Division of Medical Physics, University of Freiburg, Freiburg, Germany (M.B.); and MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands (J.J.F.)
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Kettenbach J, Kara L, Toporek G, Fuerst M, Kronreif G. A robotic needle-positioning and guidance system for CT-guided puncture: Ex vivo results. MINIM INVASIV THER 2014; 23:271-8. [PMID: 24953817 DOI: 10.3109/13645706.2014.928641] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To test the feasibility of a robotic needle-guidance platform during CT-guided puncture ex vivo. MATERIAL AND METHODS Thin copper wires inserted into a torso phantom served as targets. The phantom was placed on a carbon plate and the robot-positioning unit (RPU) of the guidance platform (iSYS Medizintechnik GmbH, Kitzbuehel, Austria) was attached. Following CT imaging and automatic registration a double oblique trajectory was planned and the RPU was remotely moved into appropriate position and angulation. A 17G-puncture needle was then manually inserted until the preplanned depth, permanently guided by the RPU. The CT scan was repeated and the distance between the actual needle tip and the target was evaluated. RESULTS Automatic registration was successful in ten experiments and the median duration of an experiment was 9.6 (6.4-46.0) minutes. The angulation of the needle path in x-y and z-axis was within 15.6° to 32.6°, and -32.8° to 3.2°, respectively and the needle insertion depth was 92.8 ± 14.4 mm. The Euclidean distance between the actual needle tip and the target was 2.3 ± 0.8 (range, 0.9-3.7) mm. CONCLUSION Automatic registration and accurate needle placement close to small targets was demonstrated. Study settings and torso phantom were very close to the clinical reality.
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Affiliation(s)
- Joachim Kettenbach
- ARTORG Center for Biomedical Engineering, University of Bern , Switzerland
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37
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Logan JK, Rais-Bahrami S, Turkbey B, Gomella A, Amalou H, Choyke PL, Wood BJ, Pinto PA. Current status of magnetic resonance imaging (MRI) and ultrasonography fusion software platforms for guidance of prostate biopsies. BJU Int 2014; 114:641-52. [PMID: 24298917 DOI: 10.1111/bju.12593] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Prostate MRI is currently the best diagnostic imaging method for detecting PCa. Magnetic resonance imaging (MRI)/ultrasonography (US) fusion allows the sensitivity and specificity of MRI to be combined with the real-time capabilities of transrectal ultrasonography (TRUS). Multiple approaches and techniques exist for MRI/US fusion and include direct 'in bore' MRI biopsies, cognitive fusion, and MRI/US fusion via software-based image coregistration platforms.
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38
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Koethe Y, Xu S, Velusamy G, Wood BJ, Venkatesan AM. Accuracy and efficacy of percutaneous biopsy and ablation using robotic assistance under computed tomography guidance: a phantom study. Eur Radiol 2014; 24:723-30. [PMID: 24220755 PMCID: PMC3945277 DOI: 10.1007/s00330-013-3056-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/24/2013] [Accepted: 10/10/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the accuracy of a robotic interventional radiologist (IR) assistance platform with a standard freehand technique for computed-tomography (CT)-guided biopsy and simulated radiofrequency ablation (RFA). METHODS The accuracy of freehand single-pass needle insertions into abdominal phantoms was compared with insertions facilitated with the use of a robotic assistance platform (n = 20 each). Post-procedural CTs were analysed for needle placement error. Percutaneous RFA was simulated by sequentially placing five 17-gauge needle introducers into 5-cm diameter masses (n = 5) embedded within an abdominal phantom. Simulated ablations were planned based on pre-procedural CT, before multi-probe placement was executed freehand. Multi-probe placement was then performed on the same 5-cm mass using the ablation planning software and robotic assistance. Post-procedural CTs were analysed to determine the percentage of untreated residual target. RESULTS Mean needle tip-to-target errors were reduced with use of the IR assistance platform (both P < 0.0001). Reduced percentage residual tumour was observed with treatment planning (P = 0.02). CONCLUSION Improved needle accuracy and optimised probe geometry are observed during simulated CT-guided biopsy and percutaneous ablation with use of a robotic IR assistance platform. This technology may be useful for clinical CT-guided biopsy and RFA, when accuracy may have an impact on outcome. KEY POINTS • A recently developed robotic intervention radiology assistance platform facilitates CT-guided interventions. • Improved accuracy of complex needle insertions is achievable. • IR assistance platform use can improve target ablation coverage.
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Affiliation(s)
- Yilun Koethe
- Center for Interventional Oncology, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
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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: 14] [Impact Index Per Article: 1.4] [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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Abstract
Multiparametric magnetic resonance imaging (mpMRI) is of interest for the diagnosis of clinically significant prostate cancer and mpMRI-targeted biopsies are being used increasingly in clinical practice. Target acquisition is performed using a range of magnet strengths and varying combinations of anatomical and functional sequences. Target identification at the time of biopsy can be carried out in the MRI scanner (in-bore biopsy) or, more commonly, the MRI-target is biopsied under ultrasonographic guidance. Many groups use cognitive or visual registration, whereby the biopsy target is identified on MRI and ultrasonography is subsequently used to direct the needle to the same location. Other groups use registration software to show prebiopsy MRI data on real-time ultrasonography. The reporting of histological results in MRI-targeted biopsy studies varies greatly. The most useful reports compare the detection of clinically significant disease in standard cores versus mpMRI-targeted cores in the same cohort of men, as recommended by the STAndards of Reporting for MRI-Targeted biopsy studies (START) consensus panel. Further evidence is needed before an mpMRI-targeted strategy can be recommended as the standard intervention for men at risk of prostate cancer.
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Robot-assisted radiofrequency ablation of primary and secondary liver tumours: early experience. Eur Radiol 2013; 24:79-85. [PMID: 23928933 PMCID: PMC3889281 DOI: 10.1007/s00330-013-2979-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/01/2013] [Accepted: 07/10/2013] [Indexed: 12/19/2022]
Abstract
Objective Computed tomography (CT)-compatible robots, both commercial and research-based, have been developed with the intention of increasing the accuracy of needle placement and potentially improving the outcomes of therapies in addition to reducing clinical staff and patient exposure to radiation during CT fluoroscopy. In the case of highly inaccessible lesions that require multiple plane angulations, robotically assisted needles may improve biopsy access and targeted drug delivery therapy by avoidance of the straight line path of normal linear needles. Methods We report our preliminary experience of performing radiofrequency ablation of the liver using a robotic-assisted CT guidance system on 11 patients (17 lesions). Results/Conclusion Robotic-assisted planning and needle placement appears to have high accuracy, is technically easier than the non-robotic-assisted procedure, and involves a significantly lower radiation dose to both patient and support staff. Key Points • An early experience of robotic-assisted radiofrequency ablation is reported • Robotic-assisted RFA improves accuracy of hepatic lesion targeting • Robotic-assisted RFA makes the procedure technically easier with significant lower radiation dose
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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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Mouraviev V, Verma S, Kalyanaraman B, Zhai QJ, Gaitonde K, Pugnale M, Donovan JF. The feasibility of multiparametric magnetic resonance imaging for targeted biopsy using novel navigation systems to detect early stage prostate cancer: the preliminary experience. J Endourol 2013; 27:820-5. [PMID: 22966987 DOI: 10.1089/end.2012.0215] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The feasibility and diagnostic performance of multiparametric magnetic resonance imaging (mp-MRI) has to be proven further. In this study, we evaluate the role of mp-MRI for targeted biopsy of early stage prostate cancer (PCa). PATIENTS AND METHODS A total 32 consecutive patients with transrectal ultrasonography (TRUS)-guided biopsy-proven PCa meeting low-risk criteria and pursuing active surveillance were selected to undergo mp-MRI 3 Tesla (3T) with endorectal coil. Patients were divided then into three groups based on the method used to target the mp-MRI designated region of interest (ROI): Group 1 underwent TRUS-guided prostate biopsy using an MRI-based coordinate plan (cognitive targeting). Group 2 underwent MRI-targeted TRUS-guided prostate biopsy using MyLabTMTwice, which superimposed the archived MRI images onto the real-time ultrasonography image allowing targeted biopsy of the ROI (fusion targeting). Group 3 included selected patients who had an elevation in prostate-specific antigen levels, or patients followed after radiation therapy (two patients) for suspicious unifocal MRI lesion recurrence. These patients underwent MRI-guided biopsy of the suspicious ROI using the navigation system DynaTRIM. RESULTS The cancer detection rate in group 1 was 33.3% (3 of 10 patients), while in group 2, it was significantly higher at 46.2%. The sensitivity and specificity for group 1 was 45.5% and 33.3%, vs 61.9% and 20.8% in group 2, respectively. The positive predictive value in group 1 was 50.0% vs 53.8% in group 2 (P=0.04). In group 3, the cancer detection rate was much higher (80%) than in group 2, (P=0.005) although the majority of these patients (7 of 10) had a previously diagnosed prostate cancer on TRUS-guided 12-core biopsy. CONCLUSION Our preliminary experience of mp-MRI suggests the detection of early stage prostate cancer with low-risk features yields potential candidates for active surveillance or focal targeted therapy. The MRI-TRUS fusion system increases diagnostic yield compared with cognitive MRI-directed TRUS-guided biopsy.
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Affiliation(s)
- Vladimir Mouraviev
- Department of Urology/Surgery, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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Borasi G, Russo G, Alongi F, Nahum A, Candiano GC, Stefano A, Gilardi MC, Messa C. High-intensity focused ultrasound plus concomitant radiotherapy: a new weapon in oncology? J Ther Ultrasound 2013; 1:6. [PMID: 24761227 PMCID: PMC3988614 DOI: 10.1186/2050-5736-1-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/14/2013] [Indexed: 12/25/2022] Open
Abstract
The potential impact of high-intensity focused ultrasound (HIFU) to general medicine and oncology seems very high. However, while in the research area, the development of this technique is very rapid and unchallenged. The direct application of HIFU to human tumour therapy is hampered by various technical difficulties, which may confine its role to a marginal device in the surgery armamentarium. To deploy the full potential of focused ultrasound in oncology, it seems necessary to review the basic relationship between HIFU and external beam radiotherapy. This is the aim of the present work.
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Affiliation(s)
| | | | | | - Alan Nahum
- Clatterbridge Cancer Centre, Bebington, CH63 4JY, UK
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Costa DN, Bloch BN, Yao DF, Sanda MG, Ngo L, Genega EM, Pedrosa I, DeWolf WC, Rofsky NM. Diagnosis of relevant prostate cancer using supplementary cores from magnetic resonance imaging-prompted areas following multiple failed biopsies. Magn Reson Imaging 2013; 31:947-52. [PMID: 23602725 DOI: 10.1016/j.mri.2013.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/24/2013] [Accepted: 02/28/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To establish the value of MRI in targeting re-biopsy for undiagnosed prostate cancer despite multiple negative biopsies and determine clinical relevance of detected tumors. MATERIALS AND METHODS Thirty-eight patients who underwent MRI after 2 or more negative biopsies due to continued clinical suspicion and later underwent TRUS-guided biopsy supplemented by biopsy of suspicious areas depicted by MRI were identified. Diagnostic performance of endorectal 3T MRI in diagnosing missed cancer foci was assessed using biopsy results as the standard of reference. Ratio of positive biopsies using systematic versus MRI-prompted approaches was compared. Gleason scores of detected cancers were used as surrogate for clinical relevance. RESULTS Thirty-four percent of patients who underwent MRI before re-biopsy had prostate cancer on subsequent biopsy. The positive biopsy yield with systematic sampling was 23% versus 92% with MRI-prompted biopsies(p<0.0001). Seventy-seven percent of tumors were detected exclusively in the MRI-prompted zones. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI to provide a positive biopsy were 92%, 60%, 55%, 94% and 71%, respectively. The anterior gland and apical regions contained most tumors; 75% of cancers detected by MRI-prompted biopsy had Gleason score≥7. CONCLUSIONS Clinically relevant tumors missed by multiple TRUS-guided biopsies can be detected by a MRI-prompted approach.
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Affiliation(s)
- Daniel N Costa
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Rothgang E, Gilson WD, Wacker F, Hornegger J, Lorenz CH, Weiss CR. Rapid freehand MR-guided percutaneous needle interventions: An image-based approach to improve workflow and feasibility. J Magn Reson Imaging 2013; 37:1202-12. [DOI: 10.1002/jmri.23894] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 09/17/2012] [Indexed: 11/11/2022] Open
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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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