Dr. Jos Immerzeel has performed over 1000 MR-ultrasound prostate biopsy procedures using bkFusion. He currently carries out bkFusion procedures at Andros Mannenkliniek in Amsterdam, and his preferred method is transperineal (TP) biopsies with local anesthesia.
For Dr. Immerzeel, an MR-ultrasound fusion biopsy using bkFusion takes approximately 20 minutes. Throughout the procedure, he keeps the patient informed about what the ultrasound images are showing in comparison with the MR scans. Overall, patients spend less than an hour at Andros Mannenkliniek when they come in for a bkFusion biopsy.
“The bkFusion workflow makes procedures very simple using the bk3000, and I usually perform 7-8 procedures per day,” he says.
In 2015, Dr. Immerzeel was looking for new alternatives to the transrectal (TR) approach for ultrasound-guided prostate biopsies. The method of “cognitive fusion,” in which a doctor uses only transrectal ultrasound guidance, was not the right fit for Dr. Immerzeel, and he sought to find a method with less risk of post-biopsy infections and urosepsis.
He began doing TP biopsies and developed a method for his procedures using local anesthesia. Dr. Immerzeel was positively surprised about how well this worked for him and his patients.
“In my experience using bkFusion for MR-ultrasound fusion procedures, I find there is hardly a risk of infection using TP, so I am often able to avoid using prophylactic antibiotics. The positioning of the patient is also a major benefit with TP, as this makes it possible to access all parts of the prostate,” says Dr. Immerzeel.
Dr. Immerzeel does all his prostate biopsies using local anesthesia, and he explains that this is one factor in how he can perform bkFusion biopsies quickly and efficiently.
“Patients typically report that they feel no significant pain, and they are able to leave the clinic immediately afterwards,” says Dr. Immerzeel, who now uses the TP method for all his patients. “Using local anesthesia as opposed to general anesthesia, I have found that my procedures are much more convenient for the patient. I find the biopsy procedures to be easier to plan and perform in an outpatient setting, as well as less costly,” he adds.
The local anesthesia wears off after about 45-60 minutes, which is more than enough time to do the whole procedure. In some cases when the anesthesia begins to wear off, it will start at the skin level first, and Dr. Immerzeel can quickly correct for this.
Dr. Immerzeel has investigated MR-ultrasound fusion biopsies with a range of different fusion solutions. He found that rigid fusion technology is better than elastic fusion because of the distortion caused in elastic fusion. Overall, he found that Predictive Fusion®, a type of rigid fusion, was superior to other fusion methods.
“Predictive Fusion® is one of the features that I think makes a difference with bkFusion. I believe that you get a better fusion image when you use Predictive Fusion® to reorient the MR image,” says Dr. Immerzeel.
Dr. Immerzeel explains that each step in the bkFusion workflow is intuitive and simple, and even the process of completing and sending the reports on the system is done quickly.