Summary: Transrectal Prostate Biopsy and Fiducial Marker
Placement in a Standard 1.5T Magnetic Resonance Imaging Scanner
Robert C. Susil,*, Cynthia Ménard,* Axel Krieger, Jonathan A. Coleman, Kevin Camphausen,
Peter Choyke, Gabor Fichtinger, Louis L. Whitcomb, C. Norman Coleman and Ergin Atalar
From the Departments of Biomedical Engineering (RCS, EA), Radiology (AK, EA), Computer Science (GF) and Mechanical Engineering
(LLW), Johns Hopkins University School of Medicine, Baltimore, Maryland, the Radiation Oncology Branch (CM, KC, CNC) and Urologic
Oncology Branch (JAC), National Cancer Institute, and Department of Radiology, Clinical Center (PC), National Institutes of Health,
DHHS, Bethesda, Maryland, the Department of Electrical and Electronics Engineering (EA), Bilkent University, Ankara, Turkey, and
University of Toronto, Princess Margaret Hospital, Toronto, Canada (CM)
Purpose: We investigated the accuracy and feasibility of a system that provides transrectal needle access to the prostate
concurrent with 1.5 Tesla MRI which previously has not been possible.
Materials and Methods: In 5 patients with previously diagnosed prostate cancer, MRI guided intraprostatic placement of
gold fiducial markers (4 procedures) and/or prostate biopsy (3 procedures) was performed using local anesthesia.
Results: Mean procedure duration was 76 minutes and all patients tolerated the intervention well. Procedure related
adverse events included self-limited hematuria and hematochezia following 3 of 8 procedures (all resolved in less than 1
week). Mean needle placement accuracy was 1.9 mm for the fiducial marker placement studies and 1.8 mm for the biopsy
procedures. Mean fiducial marker placement accuracy was 4.8 mm and the mean fiducial marker placement accuracy
transverse to the needle direction was 2.6 mm. All patients who underwent the procedure were able to complete their course
of radiotherapy without delay or complication.
Conclusions: While studies of clinical usefulness are warranted, transrectal 1.5 T MRI guided prostate biopsy and fiducial