Prostate brachytherapy training with simulated ultrasound and fluoroscopy images

In this paper, a novel computer-based virtual training system for prostate brachytherapy is presented. This system incorporates, in a novel way, prior methodologies of ultrasound image synthesis and haptic transrectal ultrasound (TRUS) transducer interaction in a complete simulator that allows a trainee to maneuver the needle and the TRUS, to see the resulting patient-specific images and feel the interaction forces. The simulated TRUS images reflect the volumetric tissue deformation and comprise validated appearance models for the needle and implanted seeds. Rendered haptic forces use validated models for needle shaft flexure and friction, tip cutting, and deflection due to bevel. This paper also presents additional new features that make the simulator complete, in the sense that all aspects of the brachytherapy procedure as practiced at many cancer centers are simulated, including simulations of seed unloading, fluoroscopy imaging, and transversal/sagittal TRUS plane switching. For real-time rendering, methods for fast TRUS-needle-seed image formation are presented. In addition, the simulator computes real-time dosimetry, allowing a trainee to immediately see the consequence of planning changes. The simulation is also patient specific, as it allows the user to import the treatment plan for a patient together with the imaging data in order for a physician to practice an upcoming procedure or for a medical resident to train using typical implant scenarios or rarely encountered cases.