Biopsym : a learning environment for transrectal ultrasound guided prostate biopsies

This paper describes a learning environment for image-guided prostate biopsies in cancer diagnosis; it is based on an ultrasound probe simulator virtually exploring real datasets obtained from patients. The aim is to make the training of young physicians easier and faster with a tool that combines lectures, biopsy simulations and recommended exercises to master this medical gesture. It will particularly help acquiring the three-dimensional representation of the prostate needed for practicing biopsy sequences. The simulator uses a haptic feedback to compute the position of the virtual probe from three-dimensional (3D) ultrasound recorded data. This paper presents the current version of this learning environment

BiopSym: a simulator for enhanced learning of ultrasound-guided prostate biopsy

This paper describes a simulator of ultrasound-guided prostate biopsies for cancer diagnosis. When performing biopsy series, the clinician has to move the ultrasound probe and to mentally integrate the real-time bi-dimensional images into a three-dimensional (3D) representation of the anatomical environment. Such a 3D representation is necessary to sample regularly the prostate in order to maximize the probability of detecting a cancer if any. To make the training of young physicians easier and faster we developed a simulator that combines images computed from three-dimensional ultrasound recorded data to haptic feedback. The paper presents the first version of this simulator

Prostate biopsy tracking with deformation estimation

Transrectal biopsies under 2D ultrasound (US) control are the current clinical standard for prostate cancer diagnosis. The isoechogenic nature of prostate carcinoma makes it necessary to sample the gland systematically, resulting in a low sensitivity. Also, it is difficult for the clinician to follow the sampling protocol accurately under 2D US control and the exact anatomical location of the biopsy cores is unknown after the intervention. Tracking systems for prostate biopsies make it possible to generate biopsy distribution maps for intra- and post-interventional quality control and 3D visualisation of histological results for diagnosis and treatment planning. They can also guide the clinician toward non-ultrasound targets. In this paper, a volume-swept 3D US based tracking system for fast and accurate estimation of prostate tissue motion is proposed. The entirely image-based system solves the patient motion problem with an a priori model of rectal probe kinematics. Prostate deformations are estimated with elastic registration to maximize accuracy. The system is robust with only 17 registration failures out of 786 (2%) biopsy volumes acquired from 47 patients during biopsy sessions. Accuracy was evaluated to 0.76$\pm$0.52mm using manually segmented fiducials on 687 registered volumes stemming from 40 patients. A clinical protocol for assisted biopsy acquisition was designed and implemented as a biopsy assistance system, which allows to overcome the draw-backs of the standard biopsy procedure.Comment: Medical Image Analysis (2011) epub ahead of prin

Towards 3D ultrasound image based soft tissue tracking: a transrectal ultrasound prostate image alignment system

The emergence of real-time 3D ultrasound (US) makes it possible to consider image-based tracking of subcutaneous soft tissue targets for computer guided diagnosis and therapy. We propose a 3D transrectal US based tracking system for precise prostate biopsy sample localisation. The aim is to improve sample distribution, to enable targeting of unsampled regions for repeated biopsies, and to make post-interventional quality controls possible. Since the patient is not immobilized, since the prostate is mobile and due to the fact that probe movements are only constrained by the rectum during biopsy acquisition, the tracking system must be able to estimate rigid transformations that are beyond the capture range of common image similarity measures. We propose a fast and robust multi-resolution attribute-vector registration approach that combines global and local optimization methods to solve this problem. Global optimization is performed on a probe movement model that reduces the dimensionality of the search space and thus renders optimization efficient. The method was tested on 237 prostate volumes acquired from 14 different patients for 3D to 3D and 3D to orthogonal 2D slices registration. The 3D-3D version of the algorithm converged correctly in 96.7% of all cases in 6.5s with an accuracy of 1.41mm (r.m.s.) and 3.84mm (max). The 3D to slices method yielded a success rate of 88.9% in 2.3s with an accuracy of 1.37mm (r.m.s.) and 4.3mm (max)

Influence of statin use on clinicopathological characteristics of localized prostate cancer and outcomes obtained after radical prostatectomy: a single center study

To assess the impact of statin use on biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP)

Intensity-Based Registration of Freehand 3D Ultrasound and CT-scan Images of the Kidney

This paper presents a method to register a pre-operative Computed-Tomography (CT) volume to a sparse set of intra-operative Ultra-Sound (US) slices. In the context of percutaneous renal puncture, the aim is to transfer planning information to an intra-operative coordinate system. The spatial position of the US slices is measured by optically localizing a calibrated probe. Assuming the reproducibility of kidney motion during breathing, and no deformation of the organ, the method consists in optimizing a rigid 6 Degree Of Freedom (DOF) transform by evaluating at each step the similarity between the set of US images and the CT volume. The correlation between CT and US images being naturally rather poor, the images have been preprocessed in order to increase their similarity. Among the similarity measures formerly studied in the context of medical image registration, Correlation Ratio (CR) turned out to be one of the most accurate and appropriate, particularly with the chosen non-derivative minimization scheme, namely Powell-Brent's. The resulting matching transforms are compared to a standard rigid surface registration involving segmentation, regarding both accuracy and repeatability. The obtained results are presented and discussed

Aid to Percutaneous Renal Access by Virtual Projection of the Ultrasound Puncture Tract onto Fluoroscopic Images

Background and Purpose: Percutaneous renal access in the context of percutaneous nephrolithotomy (PCNL) is a difficult technique, requiring rapid and precise access to a particular calix. We present a computerized system designed to improve percutaneous renal access by projecting the ultrasound puncture tract onto fluoroscopic images. Materials and Methods: The system consists of a computer and a localizer allowing spatial localization of the position of the various instruments. Without any human intervention, the ultrasound nephrostomy tract is superimposed in real time onto fluoroscopic images acquired in various views. Results: We tested our approach by laboratory experiments on a phantom. Also, after approval by our institution's Ethics Committee, we validated this technique in the operating room during PCNL in one patient. Conclusion: Our system is reliable, and the absence of image-processing procedures makes it robust. We have initiated a prospective study to validate this technique both for PCNL specialists and as a learning tool

Framework for 3D TransRectal Ultrasound

Prostate biopsies are mainly performed under 2D TransRectal UltraSound (TRUS) control by sampling the prostate according to a predefined pattern. In case of first biopsies, this pattern follows a random systematic plan. Sometimes, repeat biopsies can be needed to target regions unsampled by previous biopsies or resample critical regions (for example in case of cancer expectant management or previous prostatic intraepithelial neoplasia findings). From a clinical point of view, it could be useful to control the 3D spatial distribution of theses biopsies inside the prostate. Modern 3D-TRUS probes allow acquiring high-quality volumes of the prostate in few seconds. We developed a framework to track the prostate in 3D TRUS images. It means that if one acquires a reference volume at the beginning of the session and another during each biopsy, it is possible to determine the relationship between the prostate in the reference and the others volumes by aligning images. We used this tool to evaluate the ability of a single operator (a young urologist assistant professor) to perform a pattern of 12 biopsies under 2D TRUS guidance