Enabling Technologies for MRI-Guided Prostate Interventions

描述（申请人提供）：MRI是指导和监测前列腺癌活检和局部治疗的理想成像工具。对局灶性前列腺病变和异常的高敏感性和特异性，结合对分娩过程和随后生理变化的实时监测，具有很大的潜力。不幸的是，封闭的高场核磁共振扫描仪，最先进的成像系统，一直无法用于干预。强磁场和有限的物理空间带来了巨大的挑战，“传统”的困难，如针偏转，组织变形和目标运动增加了问题。我们的团队已经建立了mri引导前列腺活检和治疗的临床和技术可行性。我们建议将这项技术推广到我们的专业研究医院之外。特别是，我们将开发一个技术平台，用于诊断和治疗目的的精确经会阴针插入前列腺；在常规（高场封闭）MRI扫描仪内，在实时图像引导和监控下。该系统将统一适用于大范围的MRI扫描仪，支持长径、短径和高、低磁场的开放式磁铁。最初的应用将是前列腺活检和低剂量率近距离放射治疗。该系统将是强大的，简单的，并可由多学科的医生团队操作。为了实现这一目标，我们建议在约翰霍普金斯大学布里格姆妇女医院和CMS图像指导部（前身为Burdette Medical）之间建立BRP。我们的团队在磁共振引导干预、机器人技术和前列腺癌术中剂量测定治疗方面具有互补优势。研究三角关系实际上已经存在了好几年，并产生了共享的技术、出版物和发明；由政府资助。Brigham小组在RO1-5R01AG019513-03 （PI Tempany）资助下，确定了MR引导下经会阴前列腺活检和近距离治疗的临床可行性。由R01-EB002963-01 （PI: Fichtinger）共同资助，霍普金斯大学的研究小组创造了一个磁共振前列腺机器人，目前正在人体试验中进行活检和种子植入。Burdette小组开发了一套商业前列腺癌近距离治疗套件，在全球范围内安装了60多个装置，由NIH拨款5R44CA088139-04和1R43CA099374-01 （PI: Burdette）共同资助。强有力的成果、多学科的专业知识和现有的合作伙伴关系支持我们的提议。

DESCRIPTION (provided by applicant): MRI is an ideal imaging tool for guiding and monitoring prostate cancer biopsy and local therapy. The high sensitivity and specificity to focal prostate lesions and abnormalities, combined with real-time monitoring of the delivery process and subsequent physiological changes hold great potentials. Unfortunately, closed high-field MRI scanners, the most superior imaging systems, have been unavailable for interventions. The strong magnetic field and confined physical space present formidable challenges, and "conventional" difficulties such as needle deflection, tissue deformation, and target motion add to the problem. Our teams have established the clinical and technical feasibility for MRI-guided prostate biopsy and therapy. We are proposing to translate this technology outside the confines of our specialized research hospitals. In particular, we will develop a technology platform for precise trans-perineal needle placement into the prostate for both diagnostic and therapeutic purposes; inside conventional (high-field closed) MRI scanners, under real-time image guidance and monitoring. This system will be uniformly applicable to'a wide range of MRI scanners, supporting long bore, short bore, and open magnets of high and low fields alike. The initial applications will be prostate biopsy and low-dose-rate Brachytherapy. This system will be robust, simple, and operable by a multi-disciplinary team of physicians. Toward this goal, we propose a BRP between the Brigham and Women's Hospital, Johns Hopkins University, and CMS Image Guidance Division (formerly Burdette Medical). Our teams have complimentary strengths in MR guided interventions, robotics, and prostate cancer treatment with intraoperative dosimetry. A research triangle has been in de-facto existence for several years and produced shared technology, publications, and inventions; supported by government grants. The Brigham group established the clinical feasibility of MR guided transperineal prostate biopsy and brachytherapy, funded by RO1-5R01AG019513-03 (PI Tempany). The Hopkins team created an in-MRI prostate robot currently in human trials for biopsy and seed placement, co-funded by R01-EB002963-01 (PI: Fichtinger). The Burdette group developed a commercial prostate cancer brachytherapy suite with over 60 installations worldwide, co-funded by NIH grants 5R44CA088139-04 and 1R43CA099374-01 (PI: Burdette). Strong results, multidisciplinary expertise, and existing partnerships support our proposal.