title: Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls.
abstract: Multi-parametric MRI (mpMRI) is widely used in the detection and characterization of clinically- significant prostate cancer. MRI-TRUS (trans-rectal ultrasound) fusion biopsy is an in-office procedure that promises to empower urologists to successfully target these MRI-visible lesions for histological confirmation. We describe the moving parts in the process and discuss methods to optimize biopsy outcomes. mpMRI is highly technical and reader-dependent. The acquisition of US images to generate a valid 3D US model and subsequent registration and fusion requires the urologist to attain equilibrium of probe position and pressure to achieve maximum registration accuracy. Environmental, medical and engineering measures can be undertaken to improve targeting accuracy. The art and skill of 'hitting' a visual target involves real-time recognition and adjustment for potential errors/ mis-registration in the fusion guide. A multi-disciplinary team effort is critical to improve all steps of the procedure.
authors.affiliation: a Division of Urology , Duke University Medical Center , Durham , NC , USA.
authors.forename: Kae Jack
authors.initials: KJ
authors.lastname: Tay
authors.affiliation: b Department of Radiology , Duke University Medical Center , Durham , NC , USA.
authors.forename: Rajan T
authors.initials: RT
authors.lastname: Gupta
authors.affiliation: c Departments of Urology and Radiology , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: Ardeshir R
authors.initials: AR
authors.lastname: Rastinehad
authors.affiliation: a Division of Urology , Duke University Medical Center , Durham , NC , USA.
authors.forename: Efrat
authors.initials: E
authors.lastname: Tsivian
authors.affiliation: d Division of Urology, Department of Surgery , Cedars Sinai Medical Center , Los Angeles , CA , USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.affiliation: a Division of Urology , Duke University Medical Center , Durham , NC , USA.
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.affiliation: a Division of Urology , Duke University Medical Center , Durham , NC , USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
mesh_terms: D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: MRI-TRUS fusion biopsy; mpMRI; pitfalls; prostate cancer; technique