Engineering Research Center for Computer Integrated Surgical Systems and Technology1 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Cover Sheet (turn in with assignment)
• Name: _________________________________• Email or other contact: _____________________• I have followed the rules for this graded assignment
______________________Signature
201
202
PointsPoints PossibleProblem
100Total
304
303
Engineering Research Center for Computer Integrated Surgical Systems and Technology2 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
600.445 Homework #4 – Fall 2001
• Remember that this is a graded homework assignment.• You are to work alone and are not to discuss the problem
with anyone other than the TAs or the instructor.• It is otherwise open book, notes, and anything else except
previous years’ homework problems and exams.• You may not refer to previous years’ homework & exams• Please refer to the course organizational notes for a fuller
listing of all the rules. I am not reciting them all here, but they are still in effect.
• Be neat and show enough work so TAs can grade this• Unless I say otherwise in class or the TA grant an
extension, this assignment is due before the start of class on October 26, 2000.
Engineering Research Center for Computer Integrated Surgical Systems and Technology3 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Problem BackgroundThis problem concerns CIS approaches to the problem of prostate brachytherapy. The next few slides, which were graciously provided by Dr. Gabor Fichtinger, give useful background on this procedure.
Engineering Research Center for Computer Integrated Surgical Systems and Technology4 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Why Prostate?
We can make a huge differenceWe can make a huge difference– 200,000 new prostate cancer per year– 1,000,000 biopsies per year– BPH: 11,000,000 current cases– 25% of males has prostate condition
• PC, BPH, Prostatitis (chronic testicular and pelvic pain)
• Seems to be doable• Drives core research• Pre-existing experience• Strong clinical support • Industrial participation
Engineering Research Center for Computer Integrated Surgical Systems and Technology5 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Prostate diseases and treatments• Adenocarcinoma
– Prostatectomy - resection
– External beam – high energy X-ray
– Bracytherapy – implanted radioactive sources
– Experimental local therapies• Thermal (RF, Magnetic, HiFu, US, cryosurgery)• Gene therapy
• BPH– TURP– Thermal (RF, HiFu)
• Biopsy– Sextant + targeted
Engineering Research Center for Computer Integrated Surgical Systems and Technology6 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Standard Approach Today
•TRUS•Template•Manual insertion
(Burdette’s Interplant®)
Engineering Research Center for Computer Integrated Surgical Systems and Technology7 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Transrectal US guided brachytherapy
Engineering Research Center for Computer Integrated Surgical Systems and Technology8 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Transrectal Ultrasound Probe,Template, and Stepper
Engineering Research Center for Computer Integrated Surgical Systems and Technology9 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Intraoperative Patient Position and Setup
Engineering Research Center for Computer Integrated Surgical Systems and Technology10 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Transrectal Ultrasound of the Prostate
Engineering Research Center for Computer Integrated Surgical Systems and Technology11 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Prostate Implant Preplanning
Obtain axial ultrasound images of the prostate from apex to base in 5 mm increments
Base 0 mm 5 mm 10 mm 15 mm
20 mm 25 mm 30 mm Apex 35 mm
Engineering Research Center for Computer Integrated Surgical Systems and Technology12 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Defining Regions of Interest
Engineering Research Center for Computer Integrated Surgical Systems and Technology13 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Isodoses and Selection of Seed Loading
Engineering Research Center for Computer Integrated Surgical Systems and Technology14 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
The Brachytherapy Pre-Plan
Engineering Research Center for Computer Integrated Surgical Systems and Technology15 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Before insertion
(Burdette’s interplant®)
Engineering Research Center for Computer Integrated Surgical Systems and Technology16 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Urethral Sparing
Engineering Research Center for Computer Integrated Surgical Systems and Technology17 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Prescription Dose Coverage
Engineering Research Center for Computer Integrated Surgical Systems and Technology18 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
3D Volume Visualization: Seeds
Engineering Research Center for Computer Integrated Surgical Systems and Technology19 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
3D Volume Visualization: Seeds
Engineering Research Center for Computer Integrated Surgical Systems and Technology20 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Dose Volume Histograms (DVH)
Urethral (100%)
Prostate (94%)
Rectal (38%)
Engineering Research Center for Computer Integrated Surgical Systems and Technology21 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Traditional vs. Intraoperative Brachytherapy
Engineering Research Center for Computer Integrated Surgical Systems and Technology22 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Result: Implanted prostate
Engineering Research Center for Computer Integrated Surgical Systems and Technology23 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Transverse CT Slice with Dose
Engineering Research Center for Computer Integrated Surgical Systems and Technology24 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Orthogonal CT Views with Dose Overlay
Engineering Research Center for Computer Integrated Surgical Systems and Technology25 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Mess after insertion
Engineering Research Center for Computer Integrated Surgical Systems and Technology26 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
The problem
Summary: You are to sketch and compare the designs of two clearly distinct approaches to improving the procedure of prostate brachytherapy. You will then be asked to provide additional information concerning your preferred approach. Some specific questions will be later.– You may employ any intraoperative or preoperative
imaging devices you desire, with whatever preparation (e.g., fiducial implantation) is appropriate. You should consider costs and other trade-offs however.
– You should recall that the prostate itself is not visible in fluoroscopy and does not show up well in CT. MRI gives superb tissue discrimination. Ultrasound will usually enable the surgeon to identify the prostate capsule but not to see the tumors.
Engineering Research Center for Computer Integrated Surgical Systems and Technology27 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Questions 1 and 2 (20 points each)1, 2 (20 points each ): Outline the design of two distinctsystems for computer-assisted prostate brachytherapy. Your designs should include a rough sketch and a data flow block diagram along the lines of the Surgical CAD/CAM diagrams introduced in class. You should include at least the following information:
– Images used for different phases of the procedure– Identification of key analysis components, algorithms and
interface devices, explaining key inputs and outputs– Outline of procedure and how the components are used.
The two systems need to be significantly different in at least one key respect (imaging, method of providing assistance, etc.). I am not looking for a book, 1-2 pages max plus sketches per system at this point. You should make reference to the systems, technology, and other material covered in class.
Engineering Research Center for Computer Integrated Surgical Systems and Technology28 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Question 3 (30 points)
3 (30 points) Analyze and compare your proposed systems from the following perspectives:
– What are likely to be the key technical problems in implementation?
– What are the cost/performance trade-offs?– What are the other advantages and disadvantages
from the surgeon’s perspective? From the hospital’s? From the patient’s?
– How long will each take to implement? To validate?
Based on this discussion, select a preferred embodiment and justify your choice.
Engineering Research Center for Computer Integrated Surgical Systems and Technology29 600.445 Fall 2000; Updated: 28 November 2001
Copyright © R. H. Taylor
Question 4 (30 points)
3 (30 points) Now flesh out the design of your preferred embodiment. This discussion should include:
– Provide additional detail about any special apparatus you propose to create, to sufficient detail so that your answers to the other questions is clear
– Outline the key coordinate transformations and other geometric relationships in your approach
– Outline the key factors affecting accuracy & show in formulas how they relate to the transformations
– Outline how you would approach solving the key problems you identified in question 2.