MRI-guided prostate focal laser ablation therapy using a mechatronic needle guidance system

Jeremy Cepek; Uri Lindner; Sangeet Ghai; Sean R. H. Davidson; John Trachtenberg; Aaron Fenster

doi:10.1117/12.2042878

12 March 2014 MRI-guided prostate focal laser ablation therapy using a mechatronic needle guidance system

Jeremy Cepek, Uri Lindner, Sangeet Ghai, Sean R. H. Davidson, John Trachtenberg, Aaron Fenster

Proceedings Volume 9036, Medical Imaging 2014: Image-Guided Procedures, Robotic Interventions, and Modeling; 90361E (2014) https://doi.org/10.1117/12.2042878
Event: SPIE Medical Imaging, 2014, San Diego, California, United States

Abstract

Focal therapy of localized prostate cancer is receiving increased attention due to its potential for providing effective cancer control in select patients with minimal treatment-related side effects. Magnetic resonance imaging (MRI)-guided focal laser ablation (FLA) therapy is an attractive modality for such an approach. In FLA therapy, accurate placement of laser fibers is critical to ensuring that the full target volume is ablated. In practice, error in needle placement is invariably present due to pre- to intra-procedure image registration error, needle deflection, prostate motion, and variability in interventionalist skill. In addition, some of these sources of error are difficult to control, since the available workspace and patient positions are restricted within a clinical MRI bore. In an attempt to take full advantage of the utility of intraprocedure MRI, while minimizing error in needle placement, we developed an MRI-compatible mechatronic system for guiding needles to the prostate for FLA therapy. The system has been used to place interstitial catheters for MRI-guided FLA therapy in eight subjects in an ongoing Phase I/II clinical trial. Data from these cases has provided quantification of the level of uncertainty in needle placement error. To relate needle placement error to clinical outcome, we developed a model for predicting the probability of achieving complete focal target ablation for a family of parameterized treatment plans. Results from this work have enabled the specification of evidence-based selection criteria for the maximum target size that can be confidently ablated using this technique, and quantify the benefit that may be gained with improvements in needle placement accuracy.

Citation Download Citation

Jeremy Cepek, Uri Lindner, Sangeet Ghai, Sean R. H. Davidson, John Trachtenberg, and Aaron Fenster "MRI-guided prostate focal laser ablation therapy using a mechatronic needle guidance system", Proc. SPIE 9036, Medical Imaging 2014: Image-Guided Procedures, Robotic Interventions, and Modeling, 90361E (12 March 2014); https://doi.org/10.1117/12.2042878

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KEYWORDS

Prostate

Magnetic resonance imaging

Laser therapeutics

Laser ablation

Mechatronics

Cancer

Oncology

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