Objectives : reporting the design, development and experiments of a new robotic system for prostate brachytherapy including prostate tracking and MRI to Ultrasound registration. Material and methods: a robot for transperineal needle insertion has been developed. It includes the ability to track the prostate position and shape. Experiments on 90 targets inside 9 deformable phantoms have been conducted. A feasibility on 2 cadavers has also been performed. The robot had to place glass seeds simulating brachytherapy seeds as close as possible to physical targets included into the phantom or inside the prostates. A post-operative CT scan of the phantom or prostate was performed in order to measure the accuracy of the system. Results: the median accuracy was 2.73mm with a median prostate motion of 5.46mm. The accuracy in the base region was superior to the accuracy in the apex region (2.28 mm vs 3.83 mm, p<0.01) and was not significantly different for horizontal or oblique needles (2.7 vs 2.82 mm, p=0.18). Cadaver experiments demonstrated that the approach was feasible and that the robot could be used in a real clinical environment. Conclusion: the robot for prostate brachytherapy is the first system enabling prostate tracking. Targets can be accurately reached despite prostate motion and deformation. It could be applied to focal therapy for prostate cancer.
The PROSPER robot for prostate brachytherapy: design, development and preclinical evaluation.