RadVision integration with TRUS robot for Brachytherapy 600.446 Computer Integrated Surgery II Team Members: Adam Clayton Team Mentor: Peter Kazanzides 1

Background on Prostate Cancer The American Cancer Society reports that 240,890 cases of prostate cancer were diagnosed and about 33,720 men will die from it. While most cases of prostate cancer are slow growing and symptom-free. Mortality rate second only to lung cancer. Common treatments include prostatectomy, brachytherapy, external beam radiation 2

Prostate brachytherapy

Prostate brachytherapy Used to treat 46% of all cases of prostate Uses grid of holes to guide needle. Radioactive seeds injected near tumor Isotopes used as radioactive seeds have short half-life, include Palladium-103 and Iodine-125 4

Problems with conventional approach Inaccuracy of needle insertion due to template Inaccuracy of needle insertion due to imprecise targeting Unable to change orientation of needles

Goal of Project Integrate the RadVision treatment planning software with the (Trans-Rectal Ultrasound ) or TRUS brachytherapy robot. The accuracy study in which I plan to participate will assess the accuracy of the TRUS robot in needle placement.

Motivation and Significance Make needle placement more accurate Greater effectiveness of radioactive seeds with fewer side effects. Evaluate the performance of the TRUS system compared to other systems

TRUS Hardware Setup

TRUS Hardware Robot Two 2-axis Galil servo mechanisms Allows for 2D positioning as well as orientation

TRUS Hardware Button Controller Developed to allow surgeon to control robot without computer Has 4 buttons that allow for translation and orientation changes Switch for switching between “Turbo” and normal mode

Software Interaction Current Button Controller USB/Serial Robot Control DLL Galil Controller Driver Robot Ethernet

Software Interaction After RadVision Button Controller OpenIGTLink OpenIGTLink USB/Serial Microcontroller Interface Robot Control DLL Galil Controller Driver Robot Ethernet

RadVision Simulation/Treatment planning software Interfaces with OpenIGTlink

Accuracy Study Protocol by Danny Song Poke graph paper with needle Analyze with HD camera Repeat 100 times Place seeds in phantom gel

List of deliverables Minimum Deliverable Expected Deliverable User slicer or some other interface instead of Radvision with camera with phantom gel Accuracy Study using TRUS Robot. (APM task group 132 protocol) Expected Deliverable Using RadVision and real ultrasound with phantom gel. (or with slicer if dependences are not available in time) Using button box to send commands to RadVision Maximum Deliverable IRAB approved ready for clinical trial 15

List of dependencies & plan for resolving RadVision software – Currently waiting on company TRUS Robot – Already have robot Ultrasound equipment - Provided at hospital Phantom gel - Peter 16

Management Plan Meeting every other week with Professor Kazanzides 20-30 hr/wk 17

Key Dates

Reading List Gabor Fichtinger, Jonathan P. Fiene, Christopher W. Kennedy, Gernot Kronreif, Iulian Iordachita, Danny Y. Song, Everette C. Burdette, Peter Kazanzides, Robotic assistance for ultrasound-guided prostate brachytherapy, Medical Image Analysis, Volume 12, Issue 5, October 2008, Pages 535-545, ISSN 1361-8415, 10.1016/j.media.2008.06.002. (http://www.sciencedirect.com/science/article/pii/S1361841508000613) Keywords: Medical robotics; Image guided surgery; Prostate cancer; Brachytherapy 19