Robotic assistance for ultrasound-guided prostate brachytherapy

Gabor Fichtinger, Jonathan P. Fiene, Christopher W. Kennedy, Gernot Kronreif, Iulian Iordachita, Danny Y. Song, Everette C. Burdette, Peter Kazanzides

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)535-545
Number of pages11
JournalMedical image analysis
Volume12
Issue number5
DOIs
StatePublished - Oct 2008

Keywords

  • Brachytherapy
  • Image guided surgery
  • Medical robotics
  • Prostate cancer

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Computer Vision and Pattern Recognition
  • Health Informatics
  • Computer Graphics and Computer-Aided Design

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