Systems and Computers in Japan, Vol. 37, No.

1, 2006
Translated from Denshi Joho Tsushin Gakkai Ronbunshi, Vol. J87-D-II, No. 1, January 2004, pp. 281289

Development of a Virtual Needle Biopsy Simulation System for the Virtual Prostate
Daisuke Deguchi,1 Kensaku Mori,1 Yoshito Mekada,1 Jun-ichi Hasegawa,2 Jun-ichiro Toriwaki,1* and Masanori Noguchi3
1 2 3

Graduate School of Engineering, Nagoya University, Nagoya, 464-8603 Japan

School of Computer and Cognitive Sciences, Chukyo University, Toyota, 470-0393 Japan

School of Medicine, Department of Urology, Kurume University, Kurume, 830-0011 Japan

SUMMARY
This paper discusses the virtual prostate needle biopsy system and the construction of the virtual prostate model, considering the actual distribution of prostate abnormalities. A needle biopsy simulation is performed for the constructed virtual prostate, and the actual biopsy procedure in the clinical situation is evaluated. The prostate needle biopsy is a histologic diagnosis procedure in which a sample is acquired from the prostate tissue by needle biopsy and is inspected under a microscope. In order to achieve reliable prostate needle biopsy, it is necessary to consider systematically and numerically the number of needles required, and their locations and insertion angles. For such a purpose, a system is developed in which a virtual prostate is constructed on a computer and the biopsy procedure is evaluated quantitatively by performing virtually
* Now affiliated with the Faculty of Information Science, Chukyo University.

the prostate needle biopsy. Furthermore, two different models are constructed, for the prostate with and without hypertrophy, based on the actual statistical distribution data for prostate abnormalities. Each model is partitioned into the peripheral zone and the transition zone. The constructed virtual prostate is input into the virtual needle biopsy simulation system, and three different systematic biopsy procedures actually used at clinical sites, and four different needle biopsy procedures, are experimentally evaluated. The experiments show that the insertion angle that maximizes the hit probability is not always the same as the insertion angle that maximizes cancer sample acquisition. It is evident that the proposed method can indicate a biopsy procedure which realizes a high hit probability with a small number of needles. 2005 Wiley Periodicals, Inc. Syst Comp Jpn, 37(1): 93104, 2006; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/scj.20181 Key words: virtual prostate; prostate needle biopsy; virtual reality; quantitative evaluation.

Contract grant sponsors: Parts of this research were supported by a Grant-In-Aid for Scientific Research from the Ministry of Education, the 21st Century COE program, a Grant-In-Aid for Scientific Research from the Japan Society for Promotion of Science, and a Grant-In-Aid for Cancer Research from the Ministry of Health and Welfare of the Japanese Government.

1. Introduction
Prostate cancer is a cancer with a relatively low incidence rate, which is approximately 3.5% in Japan. In 2005 Wiley Periodicals, Inc. 93

European countries and the United States, on the other hand, it accounts for approximately 20% of deaths of males by cancer [1]. The incidence rate is increasing in Japan due to the rapidly westernizing lifestyle and the extension of the life span. In terms of cancer locations, the incidence rate is higher than those of lung cancer and colon cancer, and the highest of all urological diseases. It is now being intensively discussed whether it is worthwhile to apply prostate cancer examination as a national project. Several reports have been presented on the validity of mass screening for prostate cancer. There still remain several points to be solved, however, before examination is performed on the national level, and it is desirable to establish an efficient examination system [24]. Means of examination for prostate cancer include PSA (prostate-specific antigen) determination, tactile examination from the rectum, and ultrasonic tomography. When an abnormality is noticed, the next step generally is to perform a prostate needle biopsy. The prostate needle biopsy is a histologic examination procedure in which a tissue sample is acquired from the prostate by needle biopsy and is inspected by using a microscope. It is the only means of diagnosing prostate cancer. In recent years, prostate examination by PSA has been widely applied, and the opportunity to detect prostate cancer in an early stage is increasing. Thus, an important issue is how tissue samples can be acquired accurately and securely from a small pathological site, which cannot be detected by tactile examination from the rectum. Furthermore, thick 14-gauge needles (diameter approximately 2.1 mm) have conventionally been used in prostate needle biopsy, which is fairly invasive, and only a limited number of needles can be used in the biopsy. Recently, thin 18gauge biopsy needles (diameter approximately 1.2 mm) have come into use, and biopsy at six to eight points can be performed, which promotes safer and more reliable acquisition of samples [5]. At present, systematic biopsy at six points is the most general procedure. However, it is not always true that the biopsy needle acquires a pathological sample, and it is necessary to investigate the biopsy procedure systematically and numerically in terms of the number of needles, the locations, and the directions of insertion. It is thus required to develop a system that can evaluate the biopsy procedure quantitatively. In this context, we developed a prostate needle biopsy simulation system which can perform a virtual prostate needle biopsy [6, 7]. This prostate needle biopsy simulation system performs a virtual needle biopsy for a virtual prostate which is constructed from the actual sample. Consequently, the experiment is based on the actual distribution of abnormalities. However, the pattern of abnormality distribution that can be obtained is limited due to the limited number of extracted samples.

Based on the partitioning of the prostate given in Refs. 811 and the anatomical observations of the prostate given in Refs. 1217, a virtual prostate model is constructed considering the incidence rate of abnormalities obtained from the statistical data. Virtual needle biopsy is applied to the model. Specifically, the procedure is as follows. The interior of the prostate is partitioned into the peripheral zone (PZ) and the transition zone (TZ). The volume ratio of the PZ and TZ varies according to whether prostate hypertrophy is present. Consequently, the prostate model without hypertrophy (normal model) and the model with hypertrophy (hypertrophy model) are constructed. Then, an experiment is performed for a systematic biopsy with 6, 8, and 10 needles, with the needle locations used in the clinical situation, and for four other different needle locations. The performances of the biopsy procedure, as dependent on the needle locations, are compared and evaluated. In the following, Section 2 describes the virtual needle biopsy simulation system. Section 3 describes the normal and hypertrophic models of the prostate which are proposed in this paper. Section 4 describes each of the biopsy procedures under consideration. Section 5 presents experiments on the constructed model and their results. Section 6 gives a discussion.

2. Virtual Needle Biopsy Simulation System

2.1. Virtual needle biopsy simulation The virtual needle biopsy simulation is composed of the following four processes: (a) Definition of the reference plate in which to locate the virtual biopsy needles (b) Location of virtual biopsy needles in the reference plate (c) Determination of insertion angle of the virtual biopsy needles (d) Performance of virtual biopsy The detailed procedure is as follows. A left-hand coordinate system is used in the description in this paper, and clockwise rotation is defined as positive. (a) Definition of reference plate The reference plate in which to locate the virtual biopsy needle is defined as the rectangular region which corresponds to the range of needle insertion in a clinical examination. The plate is determined by specifying three points (Ltop, Lbot, Rbot) on the plane, as shown in Fig. 1. Specifically, a plane tangent to the rectal side of the prostate

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Fig. 1. (Left) Anatomy of the prostate; (right) situation of needle biopsy.

is considered. The reference plate is defined so that it is tangent to the projection of the prostate onto the above plane, and LbotLtop agrees with the direction from the cusp of the prostate to the seminal vesicle (SV). The positive direction of the normal to the reference plate is defined as the direction from the rectal side to the prostate. All biopsy needles are located on this reference plate. The unit vectors H, V, and N that determine the direction of the reference plate are defined as follows:

(b) Location of virtual biopsy needle An M N grid is defined on the reference plate. An arbitrary grid point p(i) is selected on the grid and is defined as the location of the virtual biopsy needle(i) on the reference plate. The grid point p(i) is defined as follows using m(1 m < M) and n(1 n < N):

(1) (c) Determination of insertion direction The unit vector N that determines the orientation of the reference plate is defined as the insertion reference (i) i) direction d( 0 of virtual biopsy needle . As shown in Fig. 2, the three-dimensional insertion direction vector d(i) of needle(i) is determined uniquely on the basis of two different

Here denotes the vector product, and |||| denotes the Euclidean norm of a vector.

Fig. 2. Definition of the direction of the biopsy needle.

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i) (i) (i) insertion angles ( 1 and 2 . Specifically, d is derived by the following procedure.
i) (1) H is defined as the rotation axis, and d( 0 is rotated (i) Let the obtained unit vector be d1 . by i) (2) H is defined as the rotation axis, and d( 0 is rotated (i) (i) by 1 90. Let the obtained unit vector be d2 . i) (i) (3) d( 2 is defined as the new rotation axis, and d1 is (i) (i) rotated by 2 . Let the obtained unit vector be d . i) ( 1 .

(d) Virtual needle insertion The virtual needle insertion is performed on the basis of the needle insertion parameters of the virtual biopsy needle(i), which are the location p(i), the insertion direction vector d(i), the length of sample acquisition from the tip of the biopsy needle L(i), the radius of the needle R(i), and the depth of insertion l(i), as shown in Fig. 3. We set L(i) l(i). The set of voxels S(i) where the tissue sample can be acquired by the virtual biopsy needle is expressed as follows. The start location s(i) and the tip location e(i) are expressed as (2) (3) Then,

(where denotes the scalar product of vectors). In other words, the voxels that can be acquired by a virtual needle insertion are the interior of a cylindrical region with the segment connecting the start location s(i) and the tip location e(i) as the center and with radius R(i). In S(i) and in the prostate, let the set of abnormal voxels be A(i). Specifically, A(i) is the set of voxels which are classified as abnormal in the virtual prostate within S(i), satisfying Eq. (4). In practice, tissue other than the prostate may be sampled in the virtual biopsy needle. In this system, such a region is classified as normal. 2.2. Quantitative evaluation of needle biopsy procedure In needle biopsy, a determination is made for each inserted biopsy needle whether the abnormal sample has been acquired, and if it has been acquired, the volume of the acquired tissue is calculated. When a virtual biopsy needle acquires an abnormality, it is called a hit. It is clinical knowledge that the physician can detect the disease if at least 1% of the tissue volume acquired by a biopsy needle is abnormal. In other words, the following decision formula is used: (5)

(4)

When at least one of the biopsy needles in the needle biopsy procedure is a hit, the needle biopsy procedure is called a hit. The total volume of the abnormal sample acquired by the needle biopsy procedure is defined as follows, using the set of abnormal voxels A(i) acquired by each virtual biopsy needle, the volume of a voxel, and the total number N of virtual biopsy needles inserted in the needle biopsy procedure: (6) Here, || denotes the number of pixels contained in the set. Based on the above definition, the biopsy procedure is evaluated quantitatively below by using the hit probability and the average cancer acquisition volume. 2.2.1. Hit probability The hit ratio in the case of virtual needle biopsy is defined as the hit probability of the needle biopsy procedure. It is calculated as follows:

Fig. 3. Parameter representation of the virtual biopsy needle.

hit probability[%] =

number of hit cases 100 (7) total number of cases

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Fig. 4. Definition of PZ and TZ inside the prostate.

2.2.2. Average cancer acquisition volume The abnormal volume per sample acquired by the needle biopsy procedure is defined as the average cancer acquisition volume. It is calculated as follows: total volume of acquired cancer average cancer = acquisition volume total number of cases (8) The above volume divided by the number of biopsy needles is the average volume of the cancer tissue that can be acquired by a biopsy needle.

3. Virtual Prostate Model

It is impossible to partition the prostate into PZ and TZ regions by using only the three-dimensional X-ray CT density values. Consequently, a schematic figure of the prostate is constructed as in Fig. 4, based on the partition inside the prostate [811] and the anatomical observations inside the prostate [1217]. Then, the interior region of the prostate is partitioned. As shown in Table 1, the abnormality incidence rate differs between the PZ and TZ regions in the prostate. Consequently, the volume ratio also differs. The virtual prostate model is constructed so that the volume ratio and

the abnormality incidence rate shown in Table 1 are realized. It should also be noted that the ratio of the PZ and TZ regions in the prostate differs between prostates with and without hypertrophy. Consequently, two virtual prostate models are constructed, namely, the prostate model for hypertrophy (hypertrophy model) and the prostate model without hypertrophy (normal model). Specifically, the shape of the prostate is assumed to be an ellipsoid, and the inside is partitioned [18, 19]. As the normal model, each cross section of the actually excised three-dimensional X-ray CT image is partitioned into PZ and TZ regions manually, based on the schematic figure as shown in Fig. 4. Figure 5(a) shows the cross sections of the constructed virtual prostate. Panels (b), (c), and (d) are the three-dimensional representations. The shape of the hypertrophy model is assumed to be an ellipsoid. As shown in panel (e), the region within a certain distance from the rectal side surface of the prostate is defined as the PZ region. As in the normal model, panels (f), (g), and (h) give a three-dimensional representation of the hypertrophy model. Table 2 shows the specifications for the virtual prostate, the constructed normal model, and the hypertrophy model. As is evident from the table, the constructed virtual prostate satisfies the volume ratio conditions in Table 1. The shapes of the PZ and TZ regions were examined by the physician, and were judged to be adequate.

4. Needle Biopsy Procedure

4.1. Systematic biopsy The systematic biopsy focuses systematically on the PZ, which is the most common site of prostate cancer, as shown in panels (a), (b), and (c) of Fig. 6. By systematically applying the biopsy, a detection rate which is twice that of directed biopsy focusing on the hypoechoic region in ultra-

Table 1. Volume ratio of the PZ, TZ, and CZ inside the prostate, and probabilities of the incidence of prostate cancer within each region Partition Ref. 9 Ref. 12 Proposal Volume ratio Cancer incidence rate Volume ratio Cancer incidence rate Normal model Volume ratio 2030 ml Cancer incidence rate Hypertrophy model Volume ratio above 50 ml Cancer incidence rate PZ TZ (peripheral region) (transition region) 6570% 68% 70% 70%~ 60% 75% 10% 75% 510% 24% 5% 20% 40% 25% 90% 25% CZ (central region) 25% 8% 25% 510%

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sonic tomography is realized [5]. The 8-needle systematic biopsy is the needle location method in which 2 needles for the extensive protocol, directed to the deeper side of the prostate as seen from the rectal side, are added to the 6-needle arrangement shown in Fig. 6(a). The 10-needle systematic biopsy consists of the addition of 4 extensive protocols to the PZ side. 4.2. New biopsy needle locations [Needle placement 1] We wish to cover the 10-needle systematic biopsy locations [4 needles added as in Fig. 6(c) to the 6-needle systematic biopsy arrangement shown in Fig. 6(a)] with 6 needles located at the vertices of a normal hexagon. [Needle placement 2] The needles are located at the vertices of the normal hexagon, as in placement 1, and the top two needles to be inserted into the cusp of the prostate [top two needles in Fig. 6(e)] are shifted toward the center of the prostate. [Needle placement 3] We wish to cover the 8-needle biopsy placement [2 needles added as shown in Fig. 6(b) to the 6-needle systematic biopsy placement shown in Fig. 6(a)], with the 6 needles being arranged in an H pattern. [Needle placement 4] A needle directed toward the central region is added to needle placement 1, so that the needles are located at the vertices of a normal pentagon and also at the center of gravity.

5. Experiment
The prostate needle biopsy simulation system described in this paper was implemented on a computer and was applied to the proposed normal and hypertrophy models. Based on the data in Table 1, the incidence rates of abnormalities in the constructed models were set as 75% for the PZ region and 25% for the TZ region. Four thousand virtual prostate samples were constructed, generating one

Fig. 5. Created virtual prostate model. (a) shows slices of the regular size prostate model, and its 3D shapes are shown in (b), (c), and (d). Slices of the prostate model of hypertrophy are shown in (e), and its 3D shapes are presented in (f), (g), and (h).

Table 2. Acquisition parameters of each prostate model PZ TZ (peripheral region) (transition region) Normal model Number of pixels Volume [ml] Volume ratio 574631 14.5 59% 205945 5.2 10% 392211 9.9 41% 1848728 46.5 90% PZ+TZ 966842 24.4 100% 2054673 51.7 100%

Hypertrophy model Number of pixels Volume [ml] Volume ratio

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Fig. 6. Locations of virtual needles inside biopsy plane for each biopsy method. (a), (b), and (c) show systematic 6, 8, and 10 biopsy methods, and (d), (e), (f), and (g) show biopsy method 1, 2, 3, and 4, respectively.

spherical abnormality each. We set the volume of the generated abnormality in accordance with a normal distribution with a mean of 2 ml and a standard deviation of 1 ml. The reference plate on which the virtual biopsy needles were placed was defined as a rectangle in external contact with the rectal side of the prostate, as in Fig. 1. The parameters of the virtual biopsy needle to be inserted were chosen as follows, based on data on clinically used biopsy needles. The length of tissue sample acquisition was L = 15 mm from the tip of the biopsy needle. The depth of needle insertion was l = 15 mm (l = 20 mm for only the extensive protocols in the eight-needle systematic biopsy). The radius of the needle was R = 0.6 mm. The needle insertion angle was 30 1 50 and 40 2 40 (deg). A rotation of 1 > 0 was defined as the rotation from the normal direction of the reference plate to the SV region side. Rotation by 2 was defined symmetrically with respect to the left and right from the reference plate. A needle rotation of 2 < 0 was from the direction of the center of the reference plate, and a rotation of 2 0 (deg) was toward the outer side of the reference plate. The computer used in the experiment was a Dual AthlonMP 1800+, Windows2000.

6. Discussion
Figures 7 and 8 show the average hit probability distributions when 1 and 2 are varied in the normal model and the hypertrophy model, respectively. As is evident from the figures, the obtained hit probability distribution differs for the normal and hypertrophy models. The reason for the difference is that the volume percentage of the PZ region, where the cancer incidence is high, differs greatly in the normal and the hypertrophy models. In particular, the hit probability does not change much in the hypertrophy model if the insertion angle is varied. This is attributed to the small volume of the PZ region, where the cancer incidence rate is high. Experiments were performed for the seven different needle biopsy procedures shown in Fig. 6. It is evident that the 10-needle systematic biopsy and needle placement 1 give higher hit probabilities in the range of this experiment (Table 3). In particular, needle placement 1 gives a higher value than the 8-needle systematic biopsy, even though only 6 biopsy needles are used. It is clear from Table 4, on the other hand, that a smaller volume of cancer samples can be acquired by needle placement 1 than by the other placements.

Fig. 7. For the regular size prostate model, the change of average hit probabilities (AHP) as 1 and 2 change. (a), (b), and (c) show the results of systematic 6, 8, and 10 biopsy methods, respectively. (d) shows the results of biopsy method 1.

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Fig. 8. For the hypertrophic prostate model, the change of average hit probabilities (AHP) as 1 and 2 change. (a), (b), and (c) show the results of systematic 6, 8, and 10 biopsy methods, respectively. (d) shows the results of biopsy method 1.

Thus, by using the proposed system, a needle placement that can achieve a high cancer detection rate with fewer insertion needles can be sought, considering the cancer incidence rate distribution and the size of the prostate. Furthermore, the relation between the hit probability and the acquired cancer sample volume can be investigated numerically. Even if it is difficult to perform a procedure in a clinical situation, an a priori evaluation can be made.

In the experiments with the 4000 cases of virtual prostate that were constructed, 7 hours of calculation were required per virtual biopsy needle when the angles were varied as 30 1 50 and 40 2 40 (deg). This corresponds to virtual needle insertion for approximately 2.6 107 patterns, which is a tremendous amount of computation. When simulations are performed for various procedures to be matched to individual patients, the

Table 3. For the regular size prostate model and the hypertrophic prostate model, mean, standard deviation, and maximum of the average hit probabilities when 1 and 2 change (a) Regular size prostate model Average [%] 6-needle systematic biopsy 8-needle systematic biopsy 10-needle systematic biopsy Needle location 1 Needle location 2 Needle location 3 Needle location 4 51.4 52.2 62.9 53.8 52.2 53.0 52.3 Standard deviation 8.45 8.62 9.92 9.92 8.71 7.52 9.76 (b) Hypertrophic prostate model Average [%] 6-needle systematic biopsy 8-needle systematic biopsy 10-needle systematic biopsy Needle location 1 Needle location 2 Needle location 3 Needle location 4 53.0 52.2 70.0 56.8 50.5 51.7 51.7 Standard deviation 5.86 5.50 2.98 3.87 4.26 3.48 3.39 Maximum [%] 65.7 64.6 74.4 61.8 60.7 60.6 59.1 (1, 2) (37, 40) (43, 40) (35, 2) (50, 3) (50, 1) (47, 40) (49, 30) Maximum [%] 66.9 67.1 82.0 71.4 68.1 66.2 69.0 (1, 2) (2, 7) (2, 11) (4, 3) (4, 4) (14, 1) (2, 5) (8, 3)

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Table 4. For the regular size prostate model and the hypertrophic prostate model, mean, standard deviation, and maximum of the average cancer volume acquired by a biopsy method when 1 and 2 change (a) Regular size prostate model Average [mm3] 6-needle systematic biopsy 8-needle systematic biopsy 10-needle systematic biopsy Needle location 1 Needle location 2 Needle location 3 Needle location 4 5.42 5.53 7.88 4.64 5.06 5.21 4.82 Average [mm3] 6-needle systematic biopsy 8-needle systematic biopsy 10-needle systematic biopsy Needle location 1 Needle location 2 Needle location 3 Needle location 4 4.27 4.23 7.36 4.48 4.24 4.34 4.10 Standard deviation 0.68 0.59 1.87 1.24 1.17 0.69 1.23 Standard deviation 0.51 0.51 0.63 0.44 0.42 0.34 0.40 Maximum [mm3] 6.35 6.32 10.20 6.11 6.20 6.19 6.20 Maximum [mm3] 5.43 5.56 9.38 5.50 5.39 5.55 5.11 (1, 2) (8, 39) (4, 13) (1, 40) (0, 24) (5, 39) (6, 40) (4, 29)

(b) Hypertrophic prostate model(1, 2) (1, 2) (31, 40) (50, 40) (50, 40) (50, 40) (50, 22) (50, 40) (50, 40)

computation time will be a serious problem. Speed improvement of the proposed system should be investigated in the future.

7. Conclusions
In this study, the virtual prostate model was constructed, based on anatomical knowledge and statistical data on the abnormality distributions. A prostate needle biopsy simulation system was developed on the basis of the model. Systematic biopsy procedures used in clinical situation, together with four other needle placement procedures, were considered. A quantitative evaluation is performed in terms of the hit probability and the average cancer sample acquisition volume. It was shown that by using the prostate needle biopsy simulation system proposed in this paper, large-scale experiments that are impossible in an actual clinical situation can be performed, allowing the effectiveness of parameters such as the number of biopsy needles and the insertion angle to be investigated systematically. Furthermore, by constructing two models with and without prostate hypertrophy, a simulation more closely approximating a real prostate can be achieved. Experiments show that the needle

insertion angle that maximizes the hit probability is not always the same as the insertion angle that maximizes the acquired volume. It is verified that there exists a needle biopsy procedure that can achieve a high hit probability with fewer needles. Problems remaining for the future include evaluation experiments using a large number of samples, the search for an optimal biopsy procedure using the proposed system, speed improvement of the proposed system, and evaluation by physicians.

Acknowledgments. The authors are grateful for continued discussions with members of the Toriwaki and Suenaga Laboratories at Nagoya University. They especially acknowledge the assistance provided in most of the experiments by Mr. S. Kodama of the Toriwaki Laboratory (now of the Graduate School, University of Tokyo). Parts of this research were supported by a Grant-In-Aid for Scientific Research from the Ministry of Education, the 21st Century COE program, a Grant-In-Aid for Scientific Research from the Japan Society for Promotion of Science, and a Grant-In-Aid for Cancer Research from the Ministry of Health and Welfare of the Japanese Government.

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AUTHORS

Daisuke Deguchi (student member) received a B.S. degree in 2001 from the Faculty of Engineering at Nagoya University and is now an M.E. degree candidate. He is engaged in development of flexible endoscope navigation system and prostate needle biopsy simulation system.

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AUTHORS (continued) (from left to right)

Kensaku Mori (member) received his B.S. degree in electronics engineering, M.S. degree in information engineering, and Ph.D. degree in information engineering from Nagoya University in 1992, 1994, and 1996. He was a research fellow of the Japanese Society for the Promotion of Science (JSPS) from 1994 to 1997, a research associate in the Department of Computational Science and Engineering at Nagoya University from 1997 to 2000, and an assistant professor in 2000. He became an associate professor at the Research Center for Advanced Waste and Emission Management of Nagoya University in 2001. He was a visiting associate professor in the Department of Neurosurgery at Stanford University from 2001 to 2002. He is currently an associate professor in the Graduate School of Information Science, Nagoya University. His current research interests include three-dimensional image processing, computer graphics, virtual reality and their applications to medical image. He received an award for the encouragement of research from the Japanese Society of Medical Imaging Technology in 1995, a paper award from the Japanese Society of Biomedical Engineering in 1997, the Niwa Award from the Niwa Memorial Foundation in 1998, and a Certificate of Merit award from the Radiological Society of North America in 2004. He is a member of IEICE, IEEE, Japanese Society of Biomedical Engineering, and Japanese Society of Medical Imaging Technology. Yoshito Mekada (member) received a B.S. degree in 1991 from the Department of Information, Faculty of Engineering, Nagoya University, completed the second half of the doctoral program in 1996, and became a research associate in the Department of Information Engineering at Utsunomiya University. He was appointed an associate professor of information engineering in 2001 at the Graduate School of Engineering, and an associate professor of media science in 2003 at the Graduate School of Information Science, Nagoya University. He moved to the School of Life System Science and Technology at Chukyo University as a professor in 2004. He is engaged in development of image processing and pattern recognition technology, and in research on their applications to medical image analysis. He holds a D.Eng. degree, and is a member of the Japan Medical Image Engineering Society, Computer-Assisted Diagnostics Society, IEEE.

Jun-ichi Hasegawa (member) received his B.S. degree in electrical engineering and M.S. and Ph.D. degrees in information engineering from Nagoya University in 1974, 1976, and 1979. He was a research associate and a lecturer with the Faculty of Engineering from 1979 to 1987. He moved to the School of Liberal Arts at Chukyo University as an associate professor in 1987, and became a professor in the School of Computer and Cognitive Sciences in 1992. He is currently a professor and a dean of the School of Life System Science and Technology. His research interests are in the area of pattern recognition, image understanding, and their applications to medicine and sports. He is a member of IPSJ, JSAI, JSMEBE (currently JSMBE), JAMIT, CADM, JSSF, and IEEE CS.

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AUTHORS (continued) (from left to right)

Jun-ichiro Toriwaki (member) received a B.S. degree in 1962 from the Department of Electronic Engineering at Nagoya University and completed the doctoral program in 1967. After serving as a research associate and an associate professor in the Faculty of Engineering, he became an associate professor at the Computer Center in 1974. He was appointed a professor at Toyohashi University of Technology in 1980. He moved to the Faculty of Engineering (later Faculty of Information Engineering, Graduate School of Engineering) at Nagoya University in 1983, and retired in 2003 under the age limit. Since then, he has been a professor at Chukyo University and professor emeritus at Nagoya University. He has been engaged in research on pattern recognition, image processing, graphics, and their applications to medical information. Recently he has been focusing on three-dimensional image processing, computer surgery, computer-assisted diagnosis, and virtual endoscopy. He is the author of Digital Image Processing for Image Understanding I, II (Shokodo), Three-Dimensional Digital Image Processing (Shokodo), Recognition Engineering (Corona Company), and other books. He is a member of the Information Processing Society, Computer-Assisted Image Diagnostics Society, and IEEE. Masanori Noguchi received an M.D. degree in 1980 from Kurume University School of Medicine. He has been an associate professor in the Department of Urology since 2003. He was a visiting researcher in the Department of Urology at Stanford University from 1998 to 2000. He is a member of the Japanese Urological Association, Japan Society of Clinical Oncology, Japan Cancer Society, Japanese Society of Endourology and ESWL, European Urological Association, and American Urological Association.

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