TY - JOUR
T1 - Robotic assistance for ultrasound-guided prostate brachytherapy
AU - Fichtinger, Gabor
AU - Fiene, Jonathan P.
AU - Kennedy, Christopher W.
AU - Kronreif, Gernot
AU - Iordachita, Iulian
AU - Song, Danny Y.
AU - Burdette, Everette C.
AU - Kazanzides, Peter
N1 - Funding Information:
We are grateful to Theodore L. DeWeese, MD, for clinical guidance; to Elwood Armour, PhD, and Yi Lee, PhD, for medical physics support; to Anton Deguet, MSc, for technical assistance during the clinical trials; to Wolfgang Ptacek, MSc; for mechanical design; to Jack Blevins, BS, for software modifications in the Interplant ® treatment planning system; to Daryl Carson, BS, for managing regulatory issues. This project could not have been possible without their unrelenting help and dedication. Our program has been financially supported by the US government, through DoD PC-050042, DoD PC050170, NIH 5R44 CA088139, NIH 1R41 CA106152, and the NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology under EEC-9731748.
PY - 2008/10
Y1 - 2008/10
N2 - We present a robotically assisted prostate brachytherapy system and test results in training phantoms and Phase-I clinical trials. The system consists of a transrectal ultrasound (TRUS) and a spatially co-registered robot, fully integrated with an FDA-approved commercial treatment planning system. The salient feature of the system is a small parallel robot affixed to the mounting posts of the template. The robot replaces the template interchangeably, using the same coordinate system. Established clinical hardware, workflow and calibration remain intact. In all phantom experiments, we recorded the first insertion attempt without adjustment. All clinically relevant locations in the prostate were reached. Non-parallel needle trajectories were achieved. The pre-insertion transverse and rotational errors (measured with a Polaris optical tracker relative to the template's coordinate frame) were 0.25 mm (STD = 0.17 mm) and 0.75° (STD = 0.37°). In phantoms, needle tip placement errors measured in TRUS were 1.04 mm (STD = 0.50 mm). A Phase-I clinical feasibility and safety trial has been successfully completed with the system. We encountered needle tip positioning errors of a magnitude greater than 4 mm in only 2 of 179 robotically guided needles, in contrast to manual template guidance where errors of this magnitude are much more common. Further clinical trials are necessary to determine whether the apparent benefits of the robotic assistant will lead to improvements in clinical efficacy and outcomes.
AB - We present a robotically assisted prostate brachytherapy system and test results in training phantoms and Phase-I clinical trials. The system consists of a transrectal ultrasound (TRUS) and a spatially co-registered robot, fully integrated with an FDA-approved commercial treatment planning system. The salient feature of the system is a small parallel robot affixed to the mounting posts of the template. The robot replaces the template interchangeably, using the same coordinate system. Established clinical hardware, workflow and calibration remain intact. In all phantom experiments, we recorded the first insertion attempt without adjustment. All clinically relevant locations in the prostate were reached. Non-parallel needle trajectories were achieved. The pre-insertion transverse and rotational errors (measured with a Polaris optical tracker relative to the template's coordinate frame) were 0.25 mm (STD = 0.17 mm) and 0.75° (STD = 0.37°). In phantoms, needle tip placement errors measured in TRUS were 1.04 mm (STD = 0.50 mm). A Phase-I clinical feasibility and safety trial has been successfully completed with the system. We encountered needle tip positioning errors of a magnitude greater than 4 mm in only 2 of 179 robotically guided needles, in contrast to manual template guidance where errors of this magnitude are much more common. Further clinical trials are necessary to determine whether the apparent benefits of the robotic assistant will lead to improvements in clinical efficacy and outcomes.
KW - Brachytherapy
KW - Image guided surgery
KW - Medical robotics
KW - Prostate cancer
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U2 - 10.1016/j.media.2008.06.002
DO - 10.1016/j.media.2008.06.002
M3 - Article
C2 - 18650122
AN - SCOPUS:48749092013
VL - 12
SP - 535
EP - 545
JO - Medical Image Analysis
JF - Medical Image Analysis
SN - 1361-8415
IS - 5
ER -