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MR plus ultrasound to improve breast cancer biopsies and diagnoses

Researchers at the University of Twente in the Netherlands are working on a futuristic biopsy robot — merging the best of MR and ultrasound — that may someday make diagnosing breast cancer and muscle diseases both more accurate and less expensive.

The European research project is known as MR and Ultrasound Robotic Assisted Biopsy, or MURAB. Its aim is to overcome the problems with present screening modalities for breast cancer, which result in 10 to 20 percent of patients receiving false negatives, UT researcher Foad Sojoodi Farimani, said in a statement.

Key to the robotic approach is ensuring that the best possible tissue sample is obtained. “If a mammography shows a suspicious image then we need to take a small piece of tissue for lab examination. But it’s difficult to determine precisely where the biopsy should be carried out. As a result we overlook too many patients who do indeed have a problem. That’s an issue we hope to solve,” he stated.

The MURAB project began in earnest when it got a Horizon 2020 grant of $4.6 million. Horizon 2020 is a European commission, begun in 2014, designed to place grants totaling $87 million through 2020. UT professors Stefano Stramigioli, the project leader, and Ferdi van der Heijden are also responsible for project coordination.

It’s not that accurate biopsies are impossible. One done in an MR scanner would do the trick, noted Farimani, one of MURAB’s project leaders. “MR does not generate any radiation, has no side effects, and you can determine very precisely where you should do your biopsy,” he pointed out. “But it’s very expensive and it takes about 45 to 60 minutes a patient. Even wealthier countries can’t afford any large-scale screening programs with MR.”

To see if the time and cost constraints associated with MR can be overcome in order to make it viable for screening, UT researchers — together with Siemens, KUKA, universities in Verona and Vienna, and hospitals at Radboud University Medical Center and the ZGT hospital group — have banded together to construct a robot that uses MR along with cheaper technologies that are less precise, like ultrasound and pressure sensors, to increase the accuracy of diagnosis. The goal is to reduce the time patients spend in the MR to under 20 minutes.

“This produces an offline MRI image that you can combine, during the biopsy, with online images from the ultrasound sensor,” noted Farimani. “One of the biggest challenges in this project is to use the precise MR image to locate suspicious tissue in the much more indistinct ultrasound image.”

While the initial goal is breast cancer screening, Farimani and the team are also looking at biopsies for muscle diseases — and finally to creating a technology that would work for any diagnosis involving a small piece of excised human tissue, although bringing such a device to the public is complicated, he noted, pointing out that “the robotics in this project might actually be the simplest issue. Actually getting medical technology to market is often easier said than done.”