Mixed Simulator of Transrectal & Transperineal Ultrasound Guided Prostate Biopsy


This robust, turnkey, mixed-reality simulator simulates part of an anatomically correct anus, prostate and perineum for practicing, learning, teaching and debriefing transrectal ultrasound (TRUS) guided transrectal and transperineal prostate biopsy (PBx).

Designed for austere environments, this medical simulator does not require wireless or internet access or wet fluids and accepts 110/220V, 50—60Hz. It can be unpacked and set up by a person unfamiliar with it and be operational in 5-7 minutes.

The portable simulator fits inside a military-spec padded case with inbuilt wheels and telescoping pull-handle that meets airline checked luggage size limits (L+W+H=60”) and weighs less than 50 lbs.

Using this mixed-reality simulator, we have devised a Pitch-Neutral Technique for side-fire, freehand, TRUS systematic PBx to facilitate placing biopsy core centers closer to intended template locations. View a video of the technique.

We are exploring, with our simulator, a way to safely and methodically sample the prostate anterior zone.

We can provide access to the simulator or copies of the simulator. Contact us for details.



  • Virtual model of the anatomy of the prostate, urethra, bladder and seminal vesicles
  • Tracked interoperable instruments: TRUS probe, needle, ultrasound probe, virtual camera
  • Common System of Modular Mixed and Augmented Reality Tracking Simulators (SMMARTS) modular stand for use with other modular anatomies
  • Automated scoring and replay system
  • Cognitive aids, 3D visualization and instructional materials such as online videos

TRUS sim being used



  • TRUS-guided side-fire (decubitus, supine, etc.) transrectal prostate biopsy: Templated, targeted, saturation, cognitive fusion with sagittal and optional transverse insonation planes
  • TRUS-guided end-fire (decubitus, supine, etc.) transrectal prostate biopsy: Templated, targeted, saturation, cognitive fusion with sagittal insonation plane
  • TRUS-guided transperineal prostate biopsy (lithotomy position): Templated, targeted, saturation, cognitive fusion with sagittal and transverse insonation planes

Screen capture from the TRUS sim



  • Adheres to SMMARTS rapid simulation development platform specifications
  • Quick-release placement and indexing of SMMARTS-compliant anatomies to SMMARTS platform
  • Anatomically correct virtual and physical models in the prostate library based on medical imaging scans of real humans
  • Precise sub-millimeter tracking of all tracked tools
  • High-durability skin can be rejuvenated in situ for indefinite reuse
  • Three insonation planes are simulated in the BK 8818 TRUS probe: sagittal side-fire, transverse side-fire, sagittal end-fire


  • Toggle visibility of anatomical structures
  • 3D visualization of prostate and template locations
  • Ultrasound probe with 6DOF
  • Cognitive aids for locations of colored dots in template
  • Needle stop line coaches insertion of biopsy needle
  • Virtual lesion placement
  • Cognitive aids for probe and needle orientation
  • Tactile feedback of perforating prostate
  • Debriefing with instant replay of past procedure
  • Patient groans in pain if TRUS moved with needle in

PBx Simulator Screenshot

PBx simulator definition of Deviation Magnitude