Three-Dimensional Ultrasound Guidance and Robot Assistance for Prostate Brachytherapy

  • Zhouping Wei
  • Lori Gardi
  • Chandima Edirisinghe
  • Dónal Downey
  • Aaron Fenster

Current transperineal prostate brachytherapy uses transrectal ultrasound (TRUS) guidance and a template at a fixed position to guide needles along parallel trajectories. However, pubic arch interference (PAI) with the implant path obstructs part of the prostate from being targeted by the brachytherapy needles along parallel trajectories. To solve the PAI problem, some investigators have explored other insertion trajectories, such as oblique, but the parallel trajectory constraints in current brachytherapy procedure also do not allow oblique insertion. This chapter describes a robot-assisted, threedimensional (3D) TRUS guided approach to solve this problem. Our prototype consists of a commercial robot, plus a 3D TRUS imaging system comprising an ultrasound machine, image acquisition apparatus using 3D TRUS image reconstruction, and display software. The robot positions the needle before insertion, but the physician inserts the needle into the patient’s prostate. By unifying the robot, ultrasound transducer, and the 3D TRUS image coordinate systems, the position of the template hole can be accurately related to the 3D TRUS image coordinate system, allowing accurate and consistent insertion of the needle via the template hole into the targeted position in the prostate.


Radical Prostatectomy Target Registration Error Seed Implantation Robot Assistance Prostate Brachytherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Arun KS, Huang TS, Blostein SD. (1987). Least-square fitting of two 3D point sets. IEEE Trans Pattern Anal Mach Intell, 9, 698-799CrossRefGoogle Scholar
  2. Ash D, Bottomley DM, Carey BM. (1998). Prostate brachytherapy. Prostate Cancer Prostatic Dis, 1(4), 185-188CrossRefGoogle Scholar
  3. Badiozamani KR, Wallner K, Sutlief S, Ellis W, Blasko J, Russell K. (1999). Anticipating prostatic volume changes due to prostate brachytherapy. Radiat Oncol Investig, 7(6), 360-364CrossRefGoogle Scholar
  4. Bangma CH, Hengeveld EJ, Niemer AQ, Schroder FH. (1995). Errors in transrectal ultrasonic planimetry of the prostate: Computer simulation of volumetric errors applied to a screening population. Ultrasound Med Biol, 21(1), 11-16CrossRefGoogle Scholar
  5. Bangma CH, Huland H, Schroder FH, van Cangh PJ. (2001). Early diagnosis and treatment of localized prostate cancer. Eur Urol, 40(3), 361-370CrossRefGoogle Scholar
  6. Blasko JC, Mate T, Sylvester JE, Grimm PD, Cavanagh W. (2002). Brachytherapy for carcinoma of the prostate: Techniques, patient selection, and clinical outcomes. Semin Radiat Oncol, 12(1), 81-94CrossRefGoogle Scholar
  7. Butler EB, Scardino PT, Teh BS, Uhl BM, Guerriero WG, Carlton CE, Berner BM, Dennis WS, Carpenter LS, Lu HH, Chiu JK, Kent TS, Woo SY. (1997). The Baylor College of Medicine experience with gold seed implantation. Semin Surg Oncol, 13(6), 406-418CrossRefGoogle Scholar
  8. Cheng G, Liu H, Liao L, Yu Y. (2001). Dynamic brachytherapy of the prostate under active image guidance. Proc MICCAI 2001, 2208 (LNCS), 351-359Google Scholar
  9. Ding M, Cardinal HN, Fenster A. (2003a). Automatic needle segmentation in three-dimensional ultrasound images using two orthogonal two-dimensional image projections. Med Phys, 30(2), 222-234CrossRefGoogle Scholar
  10. Ding M, Chen C, Wang Y, Gyacskov I, Fenster A. (2003b). Prostate segmentation in 3D US images using the cardinal-spline-based discrete dynamic contour. Proc SPIE, 5029, 69-76CrossRefGoogle Scholar
  11. Ding M, Fenster A. (2003). A real-time biopsy needle segmentation technique using Hough transform. Med Phys, 30(8), 2222-2233CrossRefGoogle Scholar
  12. Fenster A, Downey D. (1996). Three-dimensional ultrasound imaging: A review. IEEE Eng Med Biol, 15, 41-51CrossRefGoogle Scholar
  13. Fenster A, Downey DB, Cardinal HN. (2001). Three-dimensional ultrasound imaging. Phys Med Biol, 46(5), 67-99CrossRefGoogle Scholar
  14. Fichtinger G, Burdette EC, Tanacs A, Patriciu A, Mazilu D, Whitcomb LL, Stoianovici D. (2006). Robotically assisted prostate brachytherapy with transrectal ultrasound guidance-Phantom experiments. Brachytherapy, 5(1), 14-26CrossRefGoogle Scholar
  15. Fitzpatrick JM, West JB, Maurer CR, Jr. (1998). Predicting error in rigid-body point-based registration. IEEE Trans Med Imaging, 17(5), 694-702CrossRefGoogle Scholar
  16. Gower JC, Dijksterhuis GB. (2004). Procrustes Problems, Oxford University Press, New YorkMATHCrossRefGoogle Scholar
  17. Holm HH, Juul N, Pedersen JF, Hansen H, Stroyer I. (1983). Transperineal 125iodine seed implantation in prostatic cancer guided by transrectal ultra-sonography. J Urol, 130(2), 283-286Google Scholar
  18. Hu N, Downey DB, Fenster A, Ladak HM. (2003). Prostate boundary segmentation from 3D ultrasound images. Med Phys, 30(7), 1648-1659CrossRefGoogle Scholar
  19. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ. (2006). Cancer statistics. CA Cancer J Clin, 56(2), 106-130CrossRefGoogle Scholar
  20. Ladak HM, Mao F, Wang Y, Downey DB, Steinman DA, Fenster A. (2000). Prostate boundary segmentation from2D ultrasound images. Med Phys, 27(8), 1777-1788CrossRefGoogle Scholar
  21. Lattanzi J, McNeeley S, Donnelly S, Palacio E, Hanlon A, Schultheiss TE, Hanks GE. (2000). Ultrasound-based stereotactic guidance in prostate cancer - Quantification of organ motion and set-up errors in external beam radiation therapy. Comput Aided Surg, 5(4), 289-295Google Scholar
  22. Maurer CR, Jr., Maciunas RJ, Fitzpatrick JM. (1998). Registration of head CT images to physical space using a weighted combination of points and surfaces. IEEE Trans Med Imaging, 17(5), 753-761CrossRefGoogle Scholar
  23. Maurer CR, Jr., McCrory JJ, Fitzpatrick JM. (1993). Estimation of accuracy in localizing externally attached markers in multimodal volume head images. Proc SPIE, 1898, 43-54CrossRefGoogle Scholar
  24. McLaughlin J, Dryer D, Mao Y, Marrett L, Morrison H, Schacter B, Villeneuve G. (2006). Canadian Cancer Statistics, National Cancer Institute of Canada, Toronto, Ontario, CanadaGoogle Scholar
  25. Messing EM, Zhang JB, Rubens DJ, Brasacchio RA, Strang JG, Soni A, Schell MC, Okunieff PG, Yu Y. (1999). Intraoperative optimized inverse planning for prostate brachytherapy: Early experience. Int J Radiat Oncol Biol Phys, 44 (4), 801-808Google Scholar
  26. Nag S, Bice W, DeWyngaert K, Prestidge B, Stock R, Yu Y. (2000). The American Brachytherapy Society recommendations for permanent prostate brachy-therapy post-implant dosimetric analysis. Int J Radiat Oncol Biol Phys, 46(1), 221-230CrossRefGoogle Scholar
  27. Nath R, Anderson LL, Luxton G, Weaver KA, Williamson JF, Meigooni AS. (1995). Dosimetry of interstitial brachytherapy sources: Recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine. Med Phys, 22(2), 209-234CrossRefGoogle Scholar
  28. Norderhaug I, Dahl O, Hoisaeter PA, Heikkila R, Klepp O, Olsen DR, Kristiansen IS, Waehre H, Bjerklund Johansen TE. (2003). Brachytherapy for prostate cancer: A systematic review of clinical and cost effectiveness. Eur Urol, 44 (1), 40-46CrossRefGoogle Scholar
  29. Pathak SD, Grimm PD, Chalana V, Kim Y. (1998). Pubic arch detection in trans-rectal ultrasound guided prostate cancer therapy. IEEE Trans Med Imaging, 17 (5), 762-771CrossRefGoogle Scholar
  30. Prete JJ, Prestidge BR, Bice WS, Friedland JL, Stock RG, Grimm PD. (1998). A survey of physics and dosimetry practice of permanent prostate brachytherapy in the United States. Int J Radiat Oncol Biol Phys, 40(4), 1001-1005CrossRefGoogle Scholar
  31. Rickey DW, Picot PA, Christopher DA, Fenster A. (1995). A wall-less vessel phantom for Doppler ultrasound studies. Ultrasound Med Biol, 21(9), 1163-1176CrossRefGoogle Scholar
  32. Roy JN, Wallner KE, Harrington PJ, Ling CC, Anderson LL. (1993). A CT-based evaluation method for permanent implants: Application to prostate. Int J Radiat Oncol Biol Phys, 26(1), 163-169Google Scholar
  33. Sakr WA, Grignon DJ, Crissman JD, Heilbrun LK, Cassin BJ, Pontes JJ, Haas GP. (1994). High grade prostatic intraepithelial neoplasia (HGPIN) prostatic adenocarcinoma between the ages of 20-69: An autopsy study of 249 cases. In Vivo, 8(3), 439-443Google Scholar
  34. Shen D, Zhan Y, Davatzikos C. (2003). Segmentation of prostate boundaries from ultrasound images using statistical shape model. IEEE Trans Med Imaging, 22 (4), 539-551CrossRefGoogle Scholar
  35. Smith WL, Surry KJ, Mills GR, Downey DB, Fenster A. (2001). Three-dimensional ultrasound-guided core needle breast biopsy. Ultrasound Med Biol, 27(8), 1025-1034CrossRefGoogle Scholar
  36. Strang JG, Rubens DJ, Brasacchio RA, Yu Y, Messing EM. (2001). Real-time US versus CT determination of pubic arch interference for brachytherapy. Radiology, 219(2), 387-393Google Scholar
  37. Tong S, Cardinal HN, McLoughlin RF, Downey DB, Fenster A. (1998). Intra- and inter-observer variability and reliability of prostate volume measurement via two-dimensional and three-dimensional ultrasound imaging. Ultrasound Med Biol, 24(5), 673-681CrossRefGoogle Scholar
  38. Tong S, Downey DB, Cardinal HN, Fenster A. (1996). A three-dimensional ultra-sound prostate imaging system. Ultrasound Med Biol, 22(6), 735-746CrossRefGoogle Scholar
  39. Wan G, Wei Z, Gardi L, Downey DB, Fenster A. (2005). Brachytherapy needle deflection evaluation and correction. Med Phys, 32(4), 902-909CrossRefGoogle Scholar
  40. Wang Y, Cardinal HN, Downey DB, Fenster A. (2003). Semiautomatic three-dimensional segmentation of the prostate using two-dimensional ultrasound images. Med Phys, 30(5), 887-897CrossRefGoogle Scholar
  41. Wei Z, Gardi L, Downey DB, Fenster A. (2005). Oblique needle segmentation and tracking for 3D TRUS guided prostate brachytherapy. Med Phys, 32(9), 2928-2941CrossRefGoogle Scholar
  42. Wei Z, Gardi L, Downey DB, Fenster A. (2006). Automated localization of implanted seeds in 3D TRUS images used for prostate brachytherapy. Med Phys, 33(7), 2404-2417CrossRefGoogle Scholar
  43. Wei Z, Wan G, Gardi L, Mills G, Downey D, Fenster A. (2004). Robot-assisted 3D-TRUS guided prostate brachytherapy: System integration and validation. Med Phys, 31(3), 539-548CrossRefGoogle Scholar
  44. Yu Y, Anderson LL, Li Z, Mellenberg DE, Nath R, Schell MC, Waterman FM, Wu A, Blasko JC. (1999). Permanent prostate seed implant brachytherapy: Report of the American Association of Physicists in Medicine Task Group No. 64. Med Phys, 26(10), 2054-2076CrossRefGoogle Scholar
  45. Yu Y, Podder T, Zhang YD, Ng WS, Misic V, Sherman J, Fu L, Fuller, D, Messing E, Rubens D, Strang J, Brasacchio R. (2006). Robot-assisted prostate brachytherapy. Proc MICCAI, 4191 (LNCS), 41-49Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Zhouping Wei
    • 1
  • Lori Gardi
    • 2
  • Chandima Edirisinghe
    • 2
  • Dónal Downey
    • 3
  • Aaron Fenster
    • 2
  1. 1.Philips HealthcareClevelandUSA
  2. 2.Robarts Research InstituteLondonCanada
  3. 3.Royal Inland HospitalKamloopsCanada

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