4:12 PM Abstract No. 219 Barriers to adoption of fusion and navigation tools for biopsy and ablation

Abstract

To describe the different clinical systems for needle navigation and fusion image guidance for needle biopsy and ablation, and to better understand barriers to adoption. The different methodologies are described for guiding needle-based biopsy and ablation. The basic principles and differentiating mechanistic features are reviewed, as well as the workflow and clinical indications. Selected representative clinical cases are presented to demonstrate principles and barriers to adoption, such as setup processes, learning curves, complex interface buttons and sequence, cost, and workflow impact. TRUS + MRI fusion-guided prostate biopsy is used as an example to show these principles in fusion biopsy. Costs for in-MRI vs out-of-MRI biopsy are compared. Biopsy and ablation may benefit from facilitated needle navigation or multi-parametric guidance and real-time feedback. The ability to spatially combine morphometric (or anatomic) with functional (or metabolic) information may enable clinical procedures that would otherwise not be possible. Procedure time, patient throughput, equipment ergonomics, cost, and risk may be facilitated by familiarity with common barriers to adoption. Training tools to reduce learning curves include training videos, slides and bulky hardware setup flow charts. Registration hardware and techniques also differ in underlying mechanisms. These include: electromagnetic tracking, optical tracking, mechanical position sensing, stereotactics or robotics, image-based registration, and camera-on-ultrasound. Both PET and MRI data can be imported to the patient, instead of performing the procedure inside the PET or MRI environment, which can reduce cost. TRUS + MRI fusion-guided prostate biopsy hardware and software approaches demonstrate representative paradigms that differ in terms of underlying mechanisms, rationale, goals, cost, ease of use, and impact upon workflow. Many different registration and fusion systems and navigation techniques are useful for specific biopsy and ablation clinical scenarios, with variable indications, cost, ease of use, and impact on workflow. Better understanding of barriers to adoption may help realize theoretical benefits.