Author: Jeffrey Bax, Ian A. Cunningham, Aaron Fenster, Lori Gardi, Sule Karagulleoglu Kunduraci, Alla Reznik, David Tessier 👨🔬
Affiliation: Robarts Research Institute, Imaging Research Laboratories, Robarts Research Institute, Lakehead University 🌍
Purpose: Image-guided biopsy is critical for early diagnosis of prostate cancer (PCa), the most common cancer in men worldwide. While the prostate-specific PET (P-PET) system offers enhanced sensitivity and reduced radiation doses compared to whole-body PET, it lacks anatomical guidance for needle targeting. This study integrates P-PET with 3D TRUS-guided biopsy to combine functional and anatomical imaging, enabling real-time, accurate lesion targeting. The accuracy of a mechatronic needle guidance system was validated in a mock P-PET/3D TRUS-guided prostate biopsy.
Methods: A 3D TRUS-guided prostate biopsy system was developed, incorporating a 3D TRUS imaging, a tracking arm for alignment of the 3D TRUS and P-PET, and a mechatronic needle guidance system, integrated with a simulated P-PET system. System components were registered to align the coordinate systems, enabling accurate image fusion, and Euclidean distance errors were calculated. After 3D TRUS-based biopsy planning, needle guidance accuracy was evaluated using a prostate phantom with simulated lesions and needles inserted through template holes under 3D TRUS guidance. Needle placement errors were determined as the distance between the target center and needle centerline.
Results: The coordinate system registration of the 3D TRUS to a simulated P-PET detector plate achieved a mean Euclidean error of 0.84 ± 0.66 mm (N = 10). The needle targeting accuracy for all inclusions (N = 6) was assessed, yielding a mean targeting error of 0.85 ± 0.22 mm.
Conclusion: We developed a P-PET/3D TRUS-guided prostate biopsy system featuring a mechatronic needle guidance system. The successful integration of 3D TRUS, P-PET, and needle guidance sub-systems ensured accurate spatial alignment between the needle and target. Phantom biopsy testing confirmed sub-millimeter targeting accuracy, providing a promising solution for reducing false negatives in PCa biopsy. Future work involves integrating 3D TRUS and actual P-PET images and using PSMA radiotracer in a clinical trial.