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。对前列腺局灶性病变和异常的高度敏感性和特异性，结合对递送过程和随后的生理变化的实时监测，具有巨大的潜力。不幸的是，封闭式高场磁共振扫描仪--最优越的成像系统--一直无法用于干预。强大的磁场和有限的物理空间带来了巨大的挑战，而针头偏转、组织变形和目标运动等传统困难增加了问题的严重性。我们的团队已经确定了MRI引导的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转换到我们专门研究医院的范围之外。特别是，我们将开发一种技术平台，用于将经会阴针头精确放置到前列腺内，用于诊断和治疗目的；在传统(高场封闭)核磁共振扫描仪内，在实时图像引导和监控下。该系统将统一适用于各种磁共振扫描仪，支持长径、短径和高低场的开放式磁体。最初的应用将是前列腺活检和低剂量率近距离放射治疗。这个系统将是强大的，简单的，并可由一个多学科的医生团队操作。为了实现这一目标，我们建议在布里格姆妇女医院、约翰霍普金斯大学和CMS影像指导部门(前身为伯德特医疗)之间建立一个BRP。我们的团队在MR引导的介入、机器人技术和前列腺癌的术中剂量学治疗方面拥有互补的优势。一个研究三角实际上已经存在了几年，并产生了共享的技术、出版物和发明；得到了政府拨款的支持。Brigham小组建立了MR引导下经会阴前列腺活检和近距离放射治疗的临床可行性，由RO1-5R01AG019513-03(Pi Tempany)资助。霍普金斯研究小组创建了一种磁共振成像前列腺机器人，目前正在进行活组织检查和种子植入的人体试验，由R01-EB002963-01(PI：Fichtinger)共同资助。伯德特集团开发了一套商业前列腺癌近距离放射治疗套件，在全球范围内安装了60多个设备，由NIH赠款5R44CA088139-04和1R43CA099374-01(PI：Buradete)共同资助。强大的成果、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.