ARTEMIS - 3D Ultrascound guided Prostate Biopsy Platform with MRI Fusion
Progress in the field of MRI imaging as well as in image assessment of multiparametric MRI data (mpMRI) in the field of prostate cancer detection shows a greater sensitivity and specificity compared to traditional screening methods such as PSA screening.
The ARTEMIS prostate biopsy information and management system allows for the integration and fusion of mpMRI pictures with a real-time ultrasound image. Planning and performing targeted biopsies can be carried out on this basis. This MRI / US fusion approach is a time-saving and cost-effective alternative to in-bore biopsies.
As the only system on the market, the ARTEMIS can be configured either for transrectal or for transperineal (in development) biopsies.
The ARTEMIS provides several imaging enhancements incorporating the following features and advantages over existing technology:
- Automatic conversion of your 2D monochromatic ultrasound image to an enhanced 3D color image, which can be manipulated for the planning and management of the patient biopsy process
- A considerable increase in the ability to examine the prostate for abnormalities or suspicious areas which may need sampling
- Planning templates from standard to extended biopsies
- Integrated motion compensation
- Advanced needle navigation and tracking you are able to view in real-time
- Sophisticated recording of current biopsy sites sampled; sites can be revisited at any time
- Revisit previous sample sites / overlay previous gland volumes
The ARTEMIS contains three components:
- The ProFuse radiology suite to edit multiparametric MRI files.
- The ARTEMIS Roboter provides real-time navigation and guidance to the desired location
- The workstation for the ProFuse BX software package which includes the graphical user interface to scan, plan biopsy and report.
ARTEMIS ProFuse Radiology Suite
- The ProFuse Radiology Suite, installed on a Windows machine allows the radiologist to treat DICOM files and map abnormalities.
- In a fist step, the boundaries of the prostate will be marked on the transversal, the saggital and the coronla view.
- Suspected lesions (Regions of Interest ROI) will be indentified and marked on the different levels.
- Suspected lesions (Regions of Interest ROI) will be classified
- The different identified and marked zones can be visualized 3-dimensionally in the volume model. At the end, an export file will be sent to the Artemis ProFuse BX software for planning and execution of the biopsy.
ARTEMIS / ProFuse BX - Biopsy Planning and Management
- ARTEMIS captures the prostate image from your OEM US feed. Generating the 3D image of the prostate accomplished by a simple rotation of the ARTEMIS cradle, configured and attached to your existing US probe.
- 3D visualization of tissue structures enables comprehensive guidance and navigation of the prostate, as well as quantitative analysis for more accurate and reliable treatment planning, staging and assessment.
- See and rotate the prostate image in any dimension. Examine the tissue structure for abnormalities or any suspicious regions, which may need sampling.
- The motion-, artefact-free scanning system defines the boundary and then computes the gland volume.
The prostate gland is rendered in 3D for shape and size visualization and evaluation.
- This can be done semi- automatic as well as manually.
Semi-automatic is calculated following the placement of points along the boudary.
Manual method allows for measurement following traditional principles of length, width and hight.
- The "Urethra Delineation Function" avoids penetration of the urethra and minimize the risk of placing a biopsy site within its region.
FUSION and PLANNING
- The MRI / US fusion combines the edited MRI model with the real-time ultrasound pictures.
- The attributes of both, the MRI and the US can be found in the combined picture.
The identified "Region of Interests" (ROI) including classification are displayed in the 3D volume model as well as on the different layers.
- The targeted biopsies will be placed in the 3D volume model within the different ROI (biopsies no. 13,14, and 15)
In addition, a predefined or customized standard programm can be added (biopsies no. 1 ... 12)
- Navigation in real-time provides guidance to a desired location, maps the biopsy site and generates an image of 3D coordinates for future reference. Needle deflection due to patient movement or tissue obstruction will be displayed and can be corrected with the "Motion Control" tool.
- ARTEMIS computes the trajectory, core position and needle depht with pinpoint accuracy.
TXYZ coordinatesof the actual biopsy sites are recorded in 3D for future Reference, treatment planning and monitoring.
- Biopsy plans and recorded 3D locations from prior patient visits may be aligned to the current view for gland volume monitoring or tissue extraction from the same site, bordering tissue or to avoid previous sites.
ARCHIVE / REPORTS
- Patient information is saved in the workstations database. In addition to the biopsy information, PSA values as well as pathalogy information can be stored.
This gives you a as well a perfect instrument to accompany your patients during the active surveillance periode.
- The individual results can be summarized and displayed in a customizable report for example for a potential therapy decision.
The available graphics of the performed biopsies are as well an excellent communication tool for the discussion with your patients.
Clinical Evidence ARTEMIS
1. Feimo Shen, Katsuto Shinohara, Dinesh Kumar, Animesh Khemka, Anne R. Simoneau, Priya N. Werahera, Lu Li, Yujun Guo, Ramkrishnan Narayanan, Liyang Wei, Al Barqawi, E. David Crawford, Christos Davatzikos, Jasjit S. Suri: Three-Dimensional Sonography With Needle Tracking - Role in Diagnosis and Treatment of Prostate Cancer.J Ultrasound Med 2008; 27:895–905 • 0278-4297
2. Narayanan, R. ; Kurhanewicz, J. ; Shinohara, K. ; Crawford, E.D.: MRI-ultrasound registration for targeted prostate biopsy.IEEE International Symposium on Biomedical Imaging ISBI 09: Boston, June 28 2009-July 1 2009
3. R Narayanan, P N Werahera, A Barqawi, E D Crawford, K Shinohara, A R Simoneau4 and J S Suri: Adaptation of a 3D prostate cancer atlas for transrectal ultrasound guided target-specific biopsy.Physics in Medicine and Biology. 53 (2008) N397–N406
4. Leonard Marks, Aron Ward, Lori Gardi, Rob Bentley, Dinesh Kumar, Shruti Gupta, Maria Luz Macairan, Aaron Fenster: Tracking of prostate biopsy sites using a 3D Ultrasound device (Artemis). Presented at Annual Meeting of American Urological Association San Francisco, California May 2010
5. Yujun Guo, Priya N. Werahera, Ramkrishnan Narayanan, Lu Li, Dinesh Kumar, E. David Crawford, Jasjit S. Suri: Image Registration Accuracy of a 3-Dimensional Transrectal Ultrasound–Guided Prostate Biopsy System.J Ultrasound Med 2009; 28:1561–1568 • 0278-4297/09/
6. Derek W. Cool, Michael J. Connolly, Shi Sherebrin, Roy Eagleson, Jonathan I. Izawa, Justin Amann, Cesare Romagnoli, Walter M. Romano, Aaron Fenster: Repeat Prostate Biopsy Accuracy: - Simulator-based Comparison of Two- and Three-dimensional Transrectal US Modalities. Radiology 2010; Volume 254: Number 2, Page 587 – 594
7. Geoffrey A. Sonn, Shyam Natarajan, Daniel J. A. Margolis,* Malu MacAiran, Patricia Lieu, Jiaoti Huang, Frederick J. Dorey and Leonard S. Marks: Targeted Biopsy in the Detection of Prostate Cancer Using an Office Based Magnetic Resonance Ultrasound Fusion Device. The Journal of Urology, January 2013; Vol. 189, Page 86-92
8. Geoffrey A. Sonn, Daniel J. A. Margolis and Leonard S. Marks: Target Detection: Magnetic Resonance Imaging-Ultrasound Fusion–Guided Prostate Biopsy.Urologic Oncology, 2014 Aug; Vol. 32, Issue 6, Page 903–911.
Press Releases Artemis
Host: Anees ChagPar, MD, Francine Foss, MD, Guest Expert: Preston Sprenkle, MD, Assistant Professor in the Department of Urology, Yale School of Medicine: Targeting Biopsies for Prostat Cancer Yale Cancer Center Answers – WNPR Connecticut Public Radio
Leonard Marks: "Targeted Biopsy” - Brings New Level of Accuracy to Prostate Cancer Diagnosis.UCLA Urology Update, Fall 2012, Vol 23, No. 3, Page 1-2
Bryn Nelson: Hitting the Bull’s-Eye in Prostate Cancer - New Imaging Techniques Pioneered at NYU Langone Distinguish Deadly Lesions.NYU Physician, Winter 2012/2013, Vol 64, No. 2, Page 10 – 13
Stucki Patrick, Mattei Agostino: Die gezielte Prostatabiopsie geführt mittels Fusion zwischen 3-dimensionaler MRI und Transrektalen Ultraschall- (MRI / TRUS-Fusionsbiopsie).Luzerner Arzt, Juli 2015, Ausgabe 102, Seite51–53
Claudia Weiss: Präzise Prostatapunktion.AZ Medien 24. Juni 2015, Seite 19
Please download our brochure (PDF) for additional information.