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MP52-14 TRUS ROBOT-ASSISTED PROSTATE BIOPSY: A FEASIBILITY STUDY
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
mid-procedure, using an MR image registered with 3D imaging software, allow for accurate direction of biopsy needles to specific tumor locations. METHODS: The two-plate template was attached to a platform in a fixed position relative to a prostate phantom. A 3T MR image of the template (with gadolinium fiducials) and the phantom was obtained, and the template and phantom were registered to MRI coordinates. The MR images were uploaded onto a custom-made module in 3D slicer. Four fiducials were localized in the image and registered to their physical locations on the template, allowing the user to plan needle trajectories and calculate insertion depths to the targets. These trajectories can be manually translocated as necessary in order to minimize contact with other trajectories and nearby structures. The disposable plates were placed into a portable milling machine, which then drilled the corresponding guide holes according to the plan. The plates were replaced into the template frame, and biopsy needles were inserted into the phantom at the angle constrained by the guide holes. The phantom, template, and needles were imaged via CT scan for confirmation of placement accuracy. RESULTS: Three MRI-visible targets were identified in the image. Mean and standard deviation of error was 2.83mm 1.42 for user 1 and 4.70mm 3.66 for user 2. CONCLUSIONS: It is feasible to use a patient-specific template for low-cost, angulated transperineal MR-guided prostate biopsy. The method has potential applications not only in prostate biopsy, but also in other forms of targeted therapy. Future studies will consider further tests of accuracy, efficiency, convenience, and applicability.
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needle. Three-dimensional (3-D) image reconstruction, navigation, and core placement software were also developed to allow the geometric core distribution and to align the probe on target for biopsy with minimal motion of the probe around the prostate and between the biopsy cores. RESULTS: After IRB approval and informed consent were obtained, 3 subjects underwent TRUS Robot-guided prostate biopsy without complications. The TRUS Robot allowed a steady handling and remote manipulation of the TRUS probe during biopsy. After a manual positioning of the TRUS probe, an automated spin motion of TRUS Robot allowed the acquisition of the entire gland and its 3-D reconstruction. Selection of the extended sextant biopsy core locations was done in the images. Then, the robot oriented the TRUS probe on each target and biopsy cores were obtained manually through the needle guide under direct ultrasound visualization. TRUS Robot and software allowed a smooth and minimal movement between biopsy cores. The accuracy and precision of core targeting according to the plan were 0.49 and 0.22mm, respectively. CONCLUSIONS: TRUS Robot-guided prostate biopsy is safe and feasible. It helps define a biopsy plan, provides a mechanism to accurately sample the gland accordingly, and gives a quantitative quality control on the actual distribution of the cores. A successful TRUS Robot-guided prostate procedure provides crucial spatial information of the biopsy cores for improved cancer detection, treatment, and monitoring.
Source of Funding: Study supported by the Patrick C. Walsh Prostate Cancer Research Fund. The ultrasound equipment used in this study was provided by Hitachi Aloka Medical America, Inc.
MP52-15 Source of Funding: This research was supported by the Intramural Research Program of the National Cancer Institute, NIH
MP52-14 TRUS ROBOT-ASSISTED PROSTATE BIOPSY: A FEASIBILITY STUDY Misop Han*, Sunghwan Lim, Changhan Jun, Doru Petrisor, Dan Stoianovici, Baltimore, MD INTRODUCTION AND OBJECTIVES: A freehand TRUSguided prostate biopsy has significant limitations with spatially clustered and poorly targeted biopsy cores (J Urol. 2012 Dec;188(6):2404-9.) We have developed a novel, 4 degree of freedom (DoF) robotic TRUS probe manipulator (TRUS Robot) (Urology 2011; 77:502-7). Here, we examined the feasibility of image-guided navigation during prostate biopsy using TRUS Robot by obtaining TRUS images of the prostate gland and guiding the biopsy using a geometrically distributed biopsy cores. METHODS: TRUS Robot was updated to allow handling of an end-fire TRUS probe and an easy passage of the prostate biopsy
COMPARATIVE ASSESSMENT OF CORE BIOPSY NEEDLES Carling Cheung*, Changhan Jun, Doru Petrusor, Bruce Trock, Misop Han, Dan Stoianovici, Baltimore, MD INTRODUCTION AND OBJECTIVES: A number of core biopsy needles are available on the market. We compared the performance of six 18-gauge forward throw, fully automated types. METHODS: Measured properties are sample quality, needle tip deflection, noise level, ultrasound visibility, and needle specifications and dimensions. Sample quality (core length, weight, and fragmentation) was assessed based on cores obtained from porcine tissues. Fragmentation is defined as 0¼sample not fragmented, and 1¼ fragmented. Needle tip lateral deflection was measured at a 102 mm insertion depth in 4 media e gelatin, porcine loin, chicken breast, and bovine liver tissues. The noise level of each instrument was measured with a digital decibel meter (BAFX Productâ) at a distance of 100 mm between the needle and the meter. Ultrasound visibility was assessed with an ultrasound probe (Hitachi Preirus, EUP-B512) in water tank. RESULTS: There were significant differences in performance between the needles (Table 1). Average core length was longest with the Cook needle (9.9mm, p¼0.0002). Core fragmentation was highest with Cook (80%, p¼0.003). Average weight per core was highest with
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
mid-procedure, using an MR image registered with 3D imaging software, allow for accurate direction of biopsy needles to specific tumor locations. METHODS: The two-plate template was attached to a platform in a fixed position relative to a prostate phantom. A 3T MR image of the template (with gadolinium fiducials) and the phantom was obtained, and the template and phantom were registered to MRI coordinates. The MR images were uploaded onto a custom-made module in 3D slicer. Four fiducials were localized in the image and registered to their physical locations on the template, allowing the user to plan needle trajectories and calculate insertion depths to the targets. These trajectories can be manually translocated as necessary in order to minimize contact with other trajectories and nearby structures. The disposable plates were placed into a portable milling machine, which then drilled the corresponding guide holes according to the plan. The plates were replaced into the template frame, and biopsy needles were inserted into the phantom at the angle constrained by the guide holes. The phantom, template, and needles were imaged via CT scan for confirmation of placement accuracy. RESULTS: Three MRI-visible targets were identified in the image. Mean and standard deviation of error was 2.83mm 1.42 for user 1 and 4.70mm 3.66 for user 2. CONCLUSIONS: It is feasible to use a patient-specific template for low-cost, angulated transperineal MR-guided prostate biopsy. The method has potential applications not only in prostate biopsy, but also in other forms of targeted therapy. Future studies will consider further tests of accuracy, efficiency, convenience, and applicability.
e709
needle. Three-dimensional (3-D) image reconstruction, navigation, and core placement software were also developed to allow the geometric core distribution and to align the probe on target for biopsy with minimal motion of the probe around the prostate and between the biopsy cores. RESULTS: After IRB approval and informed consent were obtained, 3 subjects underwent TRUS Robot-guided prostate biopsy without complications. The TRUS Robot allowed a steady handling and remote manipulation of the TRUS probe during biopsy. After a manual positioning of the TRUS probe, an automated spin motion of TRUS Robot allowed the acquisition of the entire gland and its 3-D reconstruction. Selection of the extended sextant biopsy core locations was done in the images. Then, the robot oriented the TRUS probe on each target and biopsy cores were obtained manually through the needle guide under direct ultrasound visualization. TRUS Robot and software allowed a smooth and minimal movement between biopsy cores. The accuracy and precision of core targeting according to the plan were 0.49 and 0.22mm, respectively. CONCLUSIONS: TRUS Robot-guided prostate biopsy is safe and feasible. It helps define a biopsy plan, provides a mechanism to accurately sample the gland accordingly, and gives a quantitative quality control on the actual distribution of the cores. A successful TRUS Robot-guided prostate procedure provides crucial spatial information of the biopsy cores for improved cancer detection, treatment, and monitoring.
Source of Funding: Study supported by the Patrick C. Walsh Prostate Cancer Research Fund. The ultrasound equipment used in this study was provided by Hitachi Aloka Medical America, Inc.
MP52-15 Source of Funding: This research was supported by the Intramural Research Program of the National Cancer Institute, NIH
MP52-14 TRUS ROBOT-ASSISTED PROSTATE BIOPSY: A FEASIBILITY STUDY Misop Han*, Sunghwan Lim, Changhan Jun, Doru Petrisor, Dan Stoianovici, Baltimore, MD INTRODUCTION AND OBJECTIVES: A freehand TRUSguided prostate biopsy has significant limitations with spatially clustered and poorly targeted biopsy cores (J Urol. 2012 Dec;188(6):2404-9.) We have developed a novel, 4 degree of freedom (DoF) robotic TRUS probe manipulator (TRUS Robot) (Urology 2011; 77:502-7). Here, we examined the feasibility of image-guided navigation during prostate biopsy using TRUS Robot by obtaining TRUS images of the prostate gland and guiding the biopsy using a geometrically distributed biopsy cores. METHODS: TRUS Robot was updated to allow handling of an end-fire TRUS probe and an easy passage of the prostate biopsy
COMPARATIVE ASSESSMENT OF CORE BIOPSY NEEDLES Carling Cheung*, Changhan Jun, Doru Petrusor, Bruce Trock, Misop Han, Dan Stoianovici, Baltimore, MD INTRODUCTION AND OBJECTIVES: A number of core biopsy needles are available on the market. We compared the performance of six 18-gauge forward throw, fully automated types. METHODS: Measured properties are sample quality, needle tip deflection, noise level, ultrasound visibility, and needle specifications and dimensions. Sample quality (core length, weight, and fragmentation) was assessed based on cores obtained from porcine tissues. Fragmentation is defined as 0¼sample not fragmented, and 1¼ fragmented. Needle tip lateral deflection was measured at a 102 mm insertion depth in 4 media e gelatin, porcine loin, chicken breast, and bovine liver tissues. The noise level of each instrument was measured with a digital decibel meter (BAFX Productâ) at a distance of 100 mm between the needle and the meter. Ultrasound visibility was assessed with an ultrasound probe (Hitachi Preirus, EUP-B512) in water tank. RESULTS: There were significant differences in performance between the needles (Table 1). Average core length was longest with the Cook needle (9.9mm, p¼0.0002). Core fragmentation was highest with Cook (80%, p¼0.003). Average weight per core was highest with