Minimally Invasive Robotics In An MR environment


Early prostate cancer detection and treatment are of major importance to reduce mortality rate. Magnetic Resonance (MR) imaging provides images of the prostate where an early stage lesion can be visualized. The use of MR-compatible robotic systems for interventions in the prostate allows the improvement of clinical outcomes of procedures such as biopsy and brachytherapy. The goal of the MIRIAM (Minimally Invasive Robotics In An Magnetic Resonance Imaging environment) is to develop a complete system for MR-guided prostate biopsies. The project has developed a fully  autonomous robot with 9 degrees-of-freedom (DoF) used to steer and fire a biopsy needle. The system integrates a pre-operative planner to define the best insertion location, an intra-operative needle tip tracker and a needle steering algorithm.

The idea

Prostate cancer is the most common cancer in men in Europe. Patients with a high prostate specific antigen (PSA) level and irregular digital rectal exam (DRE) are screened for prostate cancer. Current procedure for prostate cancer diagnosis is using transrectal ultrasound (TRUS) guided biopsy. However, this method misses up to 31% of prostate cancer. Magnetic resonance (MR) images have better anatomical visualization compared to TRUS. In previous studies, patients with previous false negative biopsy results using TRUS were diagnosed with cancer using MR-guided biopsies. In a study at the Radboud University Nijmegen Medical Center (RUNMC) 59% of tumors were detected using MRI that previous negative TRUS biopsy results. Of these cancers 68% were in the anterior portion of the prostate; of these 57% were in the ventral transitional zone and 11% were in the peripheral zone anterior horns.

These areas are not regularly targeted with TRUS guided biopsy and therefore these cancers were repeatedly missed. This shows that MRI can use its improved visualization of the cancerous lesions for targeted biopsy. Unfortunately, neither MR nor TRUS images alone should be used for diagnosis or treatment planning of prostate cancer. Therefore, biopsies will still be taken in order to prove the occurrence of cancer in the prostate. In order to improve biopsy accuracy, the superior visualization given using MRI can be used for more precise targeting of the lesion in MR-guided biopsies and treatments.

The goal of this project is to develop and build a MR compatible device for prostate cancer biopsy and treatment. The development of a MR compatible precision device will lead to better diagnosis of prostate cancer. This will both decrease the overtreatment of patients due to the limitations associated with PSA blood tests while reducing the incidence of false-negative biopsies. Better diagnosis will lead to better treatment decisions with the possibility of providing the groundwork to establish a case for focal therapy. With a precision device these focal therapies will result in fewer side effects and increase the quality of life for the patients.


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