MR-compatible Assistance System for Biopsy in a High-Field-Strength System: Initial Results in Patients with Suspicious Prostate Lesions

Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Radiology (Impact Factor: 6.87). 03/2011; 259(3):903-10. DOI: 10.1148/radiol.11101559
Source: PubMed


To examine the feasibility and safety of magnetic resonance (MR)-guided biopsy by using a transgluteal approach in patients with suspicious prostate lesions by using an MR-compatible robotic system and a 1.5-T MR system.
The study was approved by the institutional review board of University Frankfurt, and informed consent was obtained from each patient. A total of 20 patients (age range, 57.8-71.9 years; mean age, 65.1 years) underwent biopsy in a closed-bore high-field-strength MR system. Biopsy was performed with an MR-compatible pneumatically driven robotic system. T1-weighted gradient-echo fast low-angle shot and T2-weighted true fast imaging with steady-state precession sequences were used to plan and guide the intervention with a transgluteal access on the external planning computer of the assistance system. The system calculated the trajectory and then moved the guiding arm to the insertion point. The cannula was advanced manually, and biopsies were performed with the coaxial technique by using a 15-gauge pencil tip needle. Intervention time, complications, and biopsy findings were documented.
The MR-compatible robotic system did not interfere with image quality, nor did MR imaging cause dysfunction of the robot. In one patient, the interventionist caused a fail-safe system shutdown. This was due to inadvertent displacement of the guiding arm during cannula insertion. This problem was solved by increasing the displacement threshold. Accurate coaxial cannula biopsy could be performed in all subsequent patients. Sufficient histopathologic assessment was performed in 19 patients. Insufficient material was retrieved in the patient who experienced fail-safe system shutdown. The median intervention time was 39 minutes (23-65 minutes). No procedure-related complications were observed.
Preliminary results indicate that MR-guided robot-assisted biopsy is feasible and can be performed safely with highly accurate cannula placement.

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    • "Recent advances in robotically guided interventions have been successful in assisting placement of needles or related instruments for surgery or interventional procedures [4–9]. Magnetic resonance imaging (MRI)-compatible robots have also been developed despite their significant engineering challenges and are continuing to be investigated for prostate biopsy utilising the potential advantages of multiparametric MRI. "
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    ABSTRACT: 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. We report our preliminary experience of performing radiofrequency ablation of the liver using a robotic-assisted CT guidance system on 11 patients (17 lesions). 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. • 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.
    Full-text · Article · Aug 2013 · European Radiology
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    • "Chinese scientists are also producing sealed multi-element transducers that can be coupled to the patient with a water-filled bladder [22]. In the last years, MR-compatible robots have been developed for MR-guided surgery [28] and have been modified to move an HIFU transducer within the MR bore [29,30]. Following this line of thought, we could have not just better clinical HIFU systems, but also systems whose integration in an EBRT environment would be less problematic. "
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    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.
    Full-text · Article · May 2013
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    • "Compared to US, MRI provides excellent visualization of the prostate gland with its substructures, focal lesions within the gland and surrounding periprostatic tissues and is widely believed to be the ideal modality for imaging prostate cancer (Beyersdorff et al 2002). In the recent years, researchers have been investigating the clinical utility of MRI for targeted biopsy by fusing the preprocedurally acquired MRI with the intraprocedural US (Ukimura et al 2010, Natarajan et al 2011) or by means of intraoperative MRI for needle and anatomy visualization (Cormack et al 2000, D'Amico et al 2000, Hata et al 2001, Beyersdorff et al 2002, Susil et al 2003, 2004, Menard et al 2004, Krieger et al 2005, Zangos et al 2005, Susil et al 2006, Engelhard et al 2006, Blumenfeld et al 2007, de Oliveira et al 2008, Hambrock et al 2008, Rea et al 2008, Lakosi et al 2009, Oguro et al 2009, Menard et al 2010, 2011, Yakar et al 2011, Zangos et al 2011, Schouten et al 2012). While US-guided biopsy has been emerging because of its availability, portability, and the recent progress in imaging quality of US, MRI-guided biopsy has the advantages of better soft tissue contrast and applicability to patients who cannot undergo TRUS-guided biopsy due to previous total colectomy. "
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    ABSTRACT: MRI-guided prostate biopsy in conventional closed-bore scanners requires transferring the patient outside the bore during needle insertion due to the constrained in-bore space, causing a safety hazard and limiting image feedback. To address this issue, we present our custom-made in-bore setup and software to support MRI-guided transperineal prostate biopsy in a wide-bore 3 T MRI scanner. The setup consists of a specially designed tabletop and a needle-guiding template with a Z-frame that gives a physician access to the perineum of the patient at the imaging position and allows the physician to perform MRI-guided transperineal biopsy without moving the patient out of the scanner. The software and Z-frame allow registration of the template, target planning and biopsy guidance. Initially, we performed phantom experiments to assess the accuracy of template registration and needle placement in a controlled environment. Subsequently, we embarked on our clinical trial (N = 10). The phantom experiments showed that the translational errors of the template registration along the right-left (RP) and anterior-posterior (AP) axes were 1.1 ± 0.8 and 1.4 ± 1.1 mm, respectively, while the rotational errors around the RL, AP and superior-inferior axes were (0.8 ± 1.0)°, (1.7 ± 1.6)° and (0.0 ± 0.0)°, respectively. The 2D root-mean-square (RMS) needle-placement error was 3 mm. The clinical biopsy procedures were safely carried out in all ten clinical cases with a needle-placement error of 5.4 mm (2D RMS). In conclusion, transperineal prostate biopsy in a wide-bore 3T scanner is feasible using our custom-made tabletop setup and software, which supports manual needle placement without moving the patient out of the magnet.
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