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. 2012 Feb;22(2):476-83.
doi: 10.1007/s00330-011-2259-3. Epub 2011 Sep 29.

Evaluation of a robotic technique for transrectal MRI-guided prostate biopsies

Martijn G Schouten  1 , Joyce G R Bomers, Derya Yakar, Henkjan Huisman, Eva Rothgang, Dennis Bosboom, Tom W J Scheenen, Sarthak Misra, Jurgen J Fütterer
Affiliations

Evaluation of a robotic technique for transrectal MRI-guided prostate biopsies

Martijn G Schouten et al. Eur Radiol. 2012 Feb.

Abstract

Objectives: To evaluate the accuracy and speed of a novel robotic technique as an aid to perform magnetic resonance image (MRI)-guided prostate biopsies on patients with cancer suspicious regions.

Methods: A pneumatic controlled MR-compatible manipulator with 5 degrees of freedom was developed in-house to guide biopsies under real-time imaging. From 13 consecutive biopsy procedures, the targeting error, biopsy error and target displacement were calculated to evaluate the accuracy. The time was recorded to evaluate manipulation and procedure time.

Results: The robotic and manual techniques demonstrated comparable results regarding mean targeting error (5.7 vs 5.8 mm, respectively) and mean target displacement (6.6 vs 6.0 mm, respectively). The mean biopsy error was larger (6.5 vs 4.4 mm) when using the robotic technique, although not significant. Mean procedure and manipulation time were 76 min and 6 min, respectively using the robotic technique and 61 and 8 min with the manual technique.

Conclusions: Although comparable results regarding accuracy and speed were found, the extended technical effort of the robotic technique make the manual technique - currently - more suitable to perform MRI-guided biopsies. Furthermore, this study provided a better insight in displacement of the target during in vivo biopsy procedures.

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Figures

Fig. 1
Fig. 1
a the robot with (1) the needle guide, (2) safety mechanism with the suction cup, (3) tapping mechanism to introduce the needle guide, (4) pneumatic motor, (5) tubings to the motors, (6) ground plate for installation on the MR table, (7) angulation rail to move the needle guide in the coronal plane. b set-up of a patient with the robotic technique on the table of the MR system. The patient was positioned in prone position in the MR system. After the needle guide was inserted rectally it was attached to the robot
Fig. 2
Fig. 2
Flow chart of the biopsy procedure for both the robotic and manual techniques. Scan plane adjustments were only perfomed with the IFE software (step 4) when using the robotic technique
Fig. 3
Fig. 3
Representation of the needle inside the prostate, illustrating targeting error (ε), target displacement (φ) and biopsy error (δ). The targeting error, defined as the normal distance from needle to the original target coordinate (T), is shown. Target displacement, defined as the distance between original target (T) and transformed target (T′), is represented by φ. Furthermore, the biopsy error (δ) is shown, which is defined as the normal distance between transformed target (T′) and needle
Fig. 4
Fig. 4
3D vector field: The blue arrows represent the direction and displacement of the anatomical landmarks. The red arrow is the mean vector representing target displacement. Furthermore, the needle trajectory (black line), targeting error (ε), original target (T), biopsy error (δ) and transformed target (T′) are shown
Fig. 5
Fig. 5
Transversal TRUFI image through the needle guide before (a) and after (b) needle insertion in the prostate
Fig. 6
Fig. 6
Histogram showing the mean targeting error, biopsy error and target displacement for both the robotic and manual techniques. The error bars represent the standard deviation
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