Mechatronic system for in-bore MRI-guided insertion of needles to the prostate: An in vivo needle guidance accuracy study

Cepek, Jeremy; Lindner, Uri; Ghai, Sangeet; Louis, Alyssa; Davidson, Sean M.; Gertner, Mark R.; Hlasny, Eugen; Sussman, Marshall S.; Fenster, Aaron; Trachtenberg, John

doi:10.1002/jmri.24742

Cited by 16 publications

(12 citation statements)

References 29 publications

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“…However, poor visualization of the tumor and time constraints during the ablation procedure may result in errors in placing the needle at its intended location. Inaccurate placement of the needles with respect to the tumor may lead to repeated needle insertions or incomplete treatment if the error is not detected. Errors in needle placement may be reduced by the use of MRI visible needles or needle tips .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of tumor coverage after MR‐guided prostate focal laser ablation therapy

et al. 2018

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Purpose Prostate cancer is the most common noncutaneous cancer among men in the USA. Focal laser thermal ablation (FLA) has the potential to control small tumors while preserving urinary and erectile function by leaving the neurovascular bundles and urethral sphincters intact. Accurate needle guidance is critical to the success of FLA. Multiparametric magnetic resonance images (mpMRI) can be used to identify targets, guide needles, and assess treatment outcomes. In this study, we evaluated the location of ablation zones relative to targeted lesions in 23 patients who underwent FLA therapy in a phase II trial. The ablation zone margins and unablated tumor volume were measured to determine whether complete coverage of each tumor was achieved, which would be considered a clinically successful ablation. Methods Preoperative mpMRI was acquired for each patient 2–3 months preceding the procedure and the prostate and lesion(s) were manually contoured on 3 T T2‐weighted axial images. The prostate and ablation zone(s) were also manually contoured on postablation 1.5 T T1‐weighted contrast‐enhanced axial images acquired immediately after the procedure intraoperatively. The lesion surface was nonrigidly registered to the postablation image using an initial affine registration followed by nonrigid thin‐plate spline registration of the prostate surfaces. The margins between the registered lesion and ablation zone were calculated using a uniform spherical distribution of rays, and the volume of intersection was also calculated. Each prostate was contoured five times to determine the segmentation variability and its effect on intersection of the lesion and ablation zone. Results Our study showed that the boundaries of the segmented tumor and ablation zone were close. Of the 23 lesions that were analyzed, 11 were completely covered by the ablation zone and 12 were partially covered. A shift of 1.0, 2.0, and 2.6 mm would result in 19, 21, and all tumors completely covered by the ablation zone, respectively. The median unablated tumor volume across all tumors was 0.1 mm3 with an IQR of 3.7 mm3, which was 0.2% of the median tumor volume (46.5 mm3 with an IQR of 46.3 mm3). The median extension of the tumors beyond the ablation zone, in cases which were partially ablated, was 0.9 mm (IQR of 1.3 mm), with the furthest tumor extending 2.6 mm. Conclusion In all cases, the boundary of the tumor was close to the boundary of the ablation zone, and in some cases, the boundary of the ablation zone did not completely enclose the tumor. Our results suggest that some of the ablations were not clinically successful and that there is a need for more accurate needle tracking and guidance methods. Limitations of the study include errors in the registration and segmentation methods used as well as different voxel sizes and contrast between the registered T2 and T1 MRI sequences and asymmetric swelling of the prostate postprocedurally.

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Section: Discussionmentioning

confidence: 99%

Evaluation of tumor coverage after MR‐guided prostate focal laser ablation therapy

et al. 2018

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“…A reproducible reduction of the intervention time to less than three hours would make greater use of focal therapy in the clinical routine more realistic. MR-compatible robotic systems for automated intervention control could contribute to this [49].…”

Section: Instruments and Operating Concepts For Oncologymentioning

confidence: 99%

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology

Barkhausen

Kahn

Krombach

et al. 2017

Fortschr Röntgenstr

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Background MRI is attractive for guiding and monitoring interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure flow and cardiac function. Methods Technical solutions have been developed for all procedural steps including imaging guidance, MR-safe catheters and instruments and patient monitoring. This has led to widening of the clinical applications. Interventional MRI is becoming increasingly important for the treatment of patients suffering from malignant diseases. The detectability of masses and consequently their accessibility for biopsy is higher, compared to other modalities, due to the high intrinsic soft tissue contrast of MRI. Temperature-dependent sequences allow for minimally invasive and tissue-sparing ablation (A-0 ablation). Conclusion Interventional MRI has become established in the clinical routine for a variety of indications, including biopsies and tumor ablation. Since the economic requirement of covering costs by reimbursement is met and interventional MRI decreases the mortality and morbidity of interventional procedures, broader application of interventional MRI can be expected in the clinical routine in the future. Key points Citation Format

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“…Certain MRI-guided robotic systems have progressed through clinical trials in animals or humans such as [23], [10], [1], [21]. Nevertheless, due to the formidable cost of MRI which is proportional to the imaging duration, the accumulated evidence and lessons from those clinical trials have revealed that it is imperative to minimize procedure time and thus reduce cost [21] to facilitate widespread adoption of this technique in additional hospitals.…”

Section: Introductionmentioning

confidence: 99%

An MRI-Guided Telesurgery System Using a Fabry-Perot Interferometry Force Sensor and a Pneumatic Haptic Device

Shang

et al. 2017

Ann Biomed Eng

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This paper presents a surgical master-slave teleoperationsystem for percutaneous interventional procedures under continuous magnetic resonance imaging (MRI) guidance. The slave robot consists of a piezoelectrically actuated 6-degree-of-freedom (DOF) robot for needle placement with an integrated fiber optic force sensor (I-DOF axial force measurement) using the Fabry-Perot interferometry (FPI) sensing principle; it is configured to operate inside the bore of the MRI scanner during imaging. By leveraging the advantages of pneumatic and piezoelectric actuation in force and position control respectively, we have designed a pneumatically actuated master robot (haptic device) with strain gauge based force sensing that is configured to operate the slave from within the scanner room during imaging. The slave robot follows the insertion motion of the haptic device while the haptic device displays the needle insertion force as measured by the FPI sensor. Image interference evaluation demonstrates that the telesurgery system presents a signal to noise ratio (SNR) reduction of less than 17% and less than 1% geometric distortion during simultaneous robot motion and imaging. Teleoperated needle insertion and rotation experiments were performed to reach 10 targets in a soft tissue-mimicking phantom with 0.70±0.35 mm Cartesian space error.

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Mechatronic system for in-bore MRI-guided insertion of needles to the prostate: An in vivo needle guidance accuracy study

Abstract: This system provides a reliable method of accurately aligning needle guides for in-bore transperineal needle delivery to the prostate.

Cited by 16 publications

References 29 publications

Evaluation of tumor coverage after MR‐guided prostate focal laser ablation therapy

Evaluation of tumor coverage after MR‐guided prostate focal laser ablation therapy

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology

An MRI-Guided Telesurgery System Using a Fabry-Perot Interferometry Force Sensor and a Pneumatic Haptic Device

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