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Evaluating the utility of 3D TRUS image information in guiding intra-procedure registration for motion compensation

In targeted 3D transrectal ultrasound (TRUS)-guided biopsy, patient and prostate movement during the procedure can cause target misalignments that hinder accurate sampling of pre-planned suspicious tissue locations. Multiple solutions have been proposed for motion compensation via registration of intra-procedural TRUS images to a baseline 3D TRUS image acquired at the beginning of the biopsy procedure. While 2D TRUS images are widely used for intra-procedural guidance, some solutions utilize richer intra-procedural images such as bi- or multi-planar TRUS or 3D TRUS, acquired by specialized probes. In this work, we measured the impact of such richer intra-procedural imaging on motion compensation accuracy, to evaluate the tradeoff between cost and complexity of intra-procedural imaging versus improved motion compensation. We acquired baseline and intra-procedural 3D TRUS images from 29 patients at standard sextant-template biopsy locations. We used the planes extracted from the 3D intra-procedural scans to simulate 2D and 3D information available in different clinically relevant scenarios for registration. The registration accuracy was evaluated by calculating the target registration error (TRE) using manually identified homologous fiducial markers (micro-calcifications). Our results indicate that TRE improves gradually when the number of intra-procedural imaging planes used in registration is increased. Full 3D TRUS information helps the registration algorithm to robustly converge to more accurate solutions. These results can also inform the design of a fail-safe workflow during motion compensation in a system using a tracked 2D TRUS probe, by prescribing rotational acquisitions that can be performed quickly and easily by the physician immediately prior to needle targeting.