Related Experiment Video
Updated: Aug 5, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Development and Validation of a Mixed-Reality Simulator for Reducing Biopsy Core Deviation During Simulated Freehand
Samsun Lampotang1, David E Lizdas, William T Johnson
1From the Center for Safety, Simulation & Advanced Learning Technologies (S.L., D.E.L., W.T.J., V.M., J.W., A.D., Y.A., L.M., W.B. T.S.), Office of Educational Affairs/Office of Medical Education (S.L., A.D.), Department of Anesthesiology (S.L., D.E.L., W.T.J., V.M., J.W., A.D., Y.A., L.M., W.B., T.S.), Clinical & Translational Science Institute (S.L.), and Department of Urology (L.M., W.B., T.S.), University of Florida College of Medicine, Gainesville, FL; Department of Biostatistics (X.L.), University of Florida College of Public Health and Health Professions, Gainesville, FL; Department of Emergency Medicine (Y.A.), University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey; Division of Urology, Department of Surgery (A.A.), University of Toronto, Toronto, Canada.
Introduction:
We describe the development and validation of a mixed-reality prostate biopsy (PBx) simulator with built-in guidance aids and real-time 3-dimensional visualization.
Methods:
We evaluated our simulator during one-on-one training sessions with urology residents and attendings from 2018 to 2022. Participants performed freehand, side-fire, double-sextant transrectal ultrasound-guided systematic prostate biopsy (sPBx). After a baseline assessment (first set of 12 biopsy cores), participants trained for 25 minutes with visualization and cognitive aids activated. Training was followed by an exit set of 12 biopsy cores without visualization or cognitive aids and afterward, subjective assessment by trainees of the simulator. Deviation is the shortest distance of the center of a core from its intended template location.
Results:
Baseline deviations (mean ± SD) for residents (n = 24) and attendings (n = 4) were 13.4 ± 8.9 mm and 8.5 ± 3.6 mm ( P < 0.001), respectively. Posttraining deviations were 8.7 ± 6.6 mm and 7.6 ± 3.7 mm ( P = 0.271), respectively. Deviations between baseline and exit were decreased significantly for residents ( P < 0.001) but not for attendings ( P = 0.093). Overall feedback from participants was positive. Confidence in performing a PBx increased in novices after training ( P = 0.011) and did not change among attendings ( P = 0.180).
Conclusions:
A new PBx simulator can quantify and improve accuracy during simulated freehand sPBx while providing visualization and graphical feedback. Improved simulated sPBx accuracy could lead to more even distribution of biopsy cores within the prostate when performed in clinical settings, possibly reducing the high risk of missing an existing lesion and thus decreasing the time to initiating treatment, if indicated.
