Surgical Planning Laboratory - Brigham & Women's Hospital - Boston, Massachusetts USA - a teaching affiliate of Harvard Medical School

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Evaluation of Robot-assisted MRI-guided Prostate Biopsy: Needle Path Analysis during Clinical Trials

Institution:
Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA.
Publisher:
IOP Publishing Ltd.
Publication Date:
Oct-2018
Journal:
Phys Med Biol
Volume Number:
63
Issue Number:
20
Pages:
20NT02
Citation:
Phys Med Biol. 2018 Oct 16;63(20):20NT02
PubMed ID:
30226214
Keywords:
Needle deflection, in-bore prostate biopsy, needle path analysis, robot-assisted biopsy
Appears in Collections:
NCIGT, SPL
Sponsors:
P41 EB015898/EB/NIBIB NIH HHS/United States
R01 CA111288/CA/NCI NIH HHS/United States
R01 EB020667/EB/NIBIB NIH HHS/United States
Generated Citation:
Moreira P., Patel N., Wartenberg M., Li G., Tuncali K., Heffter T., Burdette E.C., Iordachita I., Fischer G.S., Hata N., Tempany C.M.C., Tokuda J. Evaluation of Robot-assisted MRI-guided Prostate Biopsy: Needle Path Analysis during Clinical Trials. Phys Med Biol. 2018 Oct 16;63(20):20NT02 PMID: 30226214.
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While the interaction between a needle and the surrounding tissue is known to cause a significant targeting error in prostate biopsy leading to false-negative results, few studies have demonstrated how it impacts in the actual procedure. We performed a pilot study on robot-assisted MRI-guided prostate biopsy with an emphasis on the in-depth analysis of the needle-tissue interaction in-vivo. Methods: The data were acquired during in-bore transperineal prostate biopsies in patients using a 4 degrees-of-freedom (DoF) MRI-compatible robot. The anatomical structures in the pelvic area and the needle path were reconstructed from MR images, and quantitatively analyzed. We analyzed each structure individually and also proposed a mathematical model to investigate the influence of those structures in the targeting error using the mixed-model regression. Results: The median targeting error in 188 insertions (27 patients) was 6.3mm. Both the individual anatomical structure analysis and the mixed-model analysis showed that the deviation resulted from the contact between the needle and the skin as the main source of error. On contrary, needle bending inside the tissue (expressed as needle curvature) did not vary among insertions with targeting errors above and below the average. The analysis indicated that insertions crossing the bulbospongiosus presented a targeting error lower than the average. The mixed-model analysis demonstrated that the distance between the needle guide and the patient skin, the deviation at the entry point, and the path length inside the pelvic diaphragm had a statistically significant contribution to the targeting error (p<0.05). Conclusions: Our results indicate that the errors associated with the elastic contact between the needle and the skin were more prominent than the needle bending along the insertion. Our findings will help to improve the preoperative planning of transperineal prostate biopsies.