3D Real Time Breast Biopsy Machine



When the radiologist sees anomaly in the mammogram, he/she starts to investigate the reason that causes such anomaly in the image. Usually another couple of mammograms are taken to make sure that what is being seen is not an image artifact. If the new set of mammograms shows the same anomalies, then the doctor requested to image the breast with another imaging modality such as Ultra sound and MRI. Each of these image devices has its own positive and negative features. Both devices, Ultra-sound and MRI might not help if the anomaly is very small and thus it can be seen by the Mammography device but not the others.  After detailed checks, the doctor request a biopsy samples from that region of interest to indentify the nature of the anomaly tissue with 100% confidence level weather it is benign or cancerous micro calcifications


There are two ways to do the biopsy operation. One is in vertical mode as seen below on the left hand side. This is done with the same mammography machine where the biopsy needle is added to it. This setup is less friendly because the patient can see how the needle is being inserted in the breast for a duration that could last 30 minutes. The other way of doing the biopsy procedure is using a prone table as shown in the right hand side of the figure below. In this case the patient lays on her stomac and relaxes and neither can see the biopsy needle nor the extraction process, but only feels the insertion of the biopsy needle in the breast.




Figure 1 shows two modality for breast biopsy. On the left-hand-side, the mammography machine equipped with biopsy needle. In this case the patient can see all the phases of the operation and it is not comfortable to be in such position for 30 minutes.  On the right-hand-side is a prone table dedicated for breast biopsy. In this case the patient doesn’t see the biopsy needle and stays relaxed sleeping on her stomach.  Prone table is more comfortable for the patient.

Weather the biopsy is done in vertical mode or using prone table, the pointing of the biopsy needle, toward the region of interest, is carried out in the same manner. First the doctor/technician align the X-ray tube and the needle in the zero position as shown in figure 2-a. Then start to take a stereo images with +/- 15 degrees with respect to the zero position as show in figure 2-b and 2-C.  From these two oblique/stereo views of the tip of the needle and the target point, one can calculate the position of the tip of the needle from the target point as show in figure 3.

 



Figure 2a shows a schematic of the top view of the probe table for breast biopsy. The zero position is when both the x-ray tube and the needle axis are aligned.

 

Figure 2b Same as in 2a but here it shows the position of the X-ray tube at +15 degrees with respect of the biopsy needle axis.






Figure 2C Same as in 2A and 2B but here it shows the position of the X-ray tube at -15 degrees with respect of the biopsy needle axis



Figure 3 shows the display of the two views prediction of the position of the tip of the biopsy needle from the target

During the biopsy intervention, the doctor/technician takes around 30 X-ray images in order to insert the biopsy needle carefully and correctly. Moreover the needle has to take around 10 samples to make sure that at least few samples have been taken from the region of interest to sends to the Lab for further analysis. The whole intervention could take 30 minutes or more, depending on the skill and the experience of the operator of the biopsy machine.  One of the difficulties in reaching the region of interest is that the breast tissue is soft and dynamic and quiet often, while the needle is pointing correctly to reach the region of interest the tip of the needle pushes the region of interest back instead of penetrating it.

The 3D real time biopsy machine is a device that has been developed by Physicists and Engineers on the request of Medical Doctor specialized in Mammography.  A collaboration was founded between UDIAT-Parc-Tauli (Sabadell) and Centro Nacional de Microelectronics (CNM-IBM) in Bellaterra and Institut de Física d'Altes Energies (IFAE) in Bellaterra, to develop a new generation of breast biopsy machine that overcome the limitation of the existing devices in the market. The collaboration has embarked on developing a new prone table, using Hologic prone table as chassis, and add extra modification to make it possible to take many frames/second with additional mini oblique views , +/- 1.5 degrees  with regard to the major oblique view which could be either +15 or -15 degrees as one can see in fig. 4. The + or -15 degrees gives us a good stereo view to see clearly the tip of the needle and the region of interest. The swinging of +/-1.5 degrees, gives us two views around the stereo axis of + or -15 degrees. These two images are taken with the same position of the biopsy needle inside the breast. When these two views are combined on special monitor and using special glasses, then the operator can see the compressed breast as 3D volume with the needle inside making it clear where the tip of the biopsy needle with respect the region of interest. The multi-frames per second (real time) allow the operator (doctor/technician) to guide the needle in the breast quasi online, making the intervention simpler and shorter and this will reduce the pressure and the stress on the operator and the trauma on the patient. Moreover this new biopsy machine will make the intervention as cost effective given that such biopsy machine is able to handle larger number of patients in comparable to the currently used in the market.



Figure 4. Same as fig 2C but here the X-ray tube-sensor axis moves +/- 1.5 degrees with respect to the main axis at -15 degrees. This will allows us to have two views at +1.5 and -1.5 degrees from which we construct, in the brain, the 3D view of the breast with the biopsy needle inside.


The 3D-real biopsy machine was constructed using an old Hologic Prone breast biopsy table as shown in fig.5

 

 

Figure 5 shows the 3D-realtime breast biopsy machine. Monitor #1 has two functions. In one mode it can display the mammogram of interest from the PACs. In another mode it set the parameters of the X-ray tube and related to the zero coordinates of the biopsy needle. Monitor 2 is to displace the two views at +1.5 and -1.5 degrees with respect the nominal axis of the Xray tube-sensor with respect to the +15 degrees with respect to the biopsy needle axis. It is possible to remove monitor #2 and replace it with the special video eye-glasses made by Zeiss optics in which each view is displaced on one glass and the brain reconstruct the 3D image.

The 3D-realtile biopsy machine was present in the “Salon International Des Inventions” in Geneva, Switzerland 2008, and the invention was awarded Silver medal, as in figure 6.

 

 

Figure 6 shows the diploma and the corresponding silver medal

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