Fig. 1

Overview of workflow used to perform patient specific simulation for IRE treatment performed on a 70-year-old man with Gleason 9 recurrence after radiation therapy (patient 6). a T1 weighted post contrast MRI showed a tumor (center marked with an asterisk, boundary with solid line) in the right peripheral zone. b Intra-operative axial US guided needle placement to the tumor (5 IRE needles, white arrows). The intra-operative US image annotated to demarcate the ablation probes (dashed arrows), the outline of the prostate, the rectum, and the neurovascular bundles (NVB) (solid lines). Clinical treatment planning data were compiled and the MR images from the corresponding axial plane were used to identify critical structures for segmentation. c Follow-up axial enhanced T1w with fat saturation MR imaging performed 15 days after ablation was used to demarcate the ablation defect (solid line) and showed size and shape of the ablative zone (area: 701 mm²). d Simulation predicted ablation zone (white with blue boundary) at the electric field strength contour (700 V/cm; area 624 mm², arrowhead). Image plotted using gradient shading with regions of highest field strength (700 V/cm and stronger) appearing light and lower field strengths appearing dark. Simulation predicted that ablation encompassed completely the tumor