Realization of a biomechanical model-assisted image guidance system for breast cancer surgery using supine MRI.
Realization of a biomechanical model-assisted image guidance system for breast cancer surgery using supine MRI.
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DOI：
10.1007/s11548-015-1235-9
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发表时间：
2015-12
影响因子：
3
通讯作者：
Miga MI
中科院分区：
文献类型：
--
作者：
Conley RH;Meszoely IM;Weis JA;Pheiffer TS;Arlinghaus LR;Yankeelov TE;Miga MI
不幸的是，目前由于切缘阳性而进行保乳手术的再切除率平均为20- 40%。高的再切除率是由于术中难以定位肿瘤边界和缺乏关于残留疾病存在的实时信息。本文介绍的工作介绍了仰卧位磁共振（MR）图像，数字化技术和生物力学模型的使用，以调查使用图像引导系统定位肿瘤术中的能力。术前仰卧位MR图像用于创建乳腺组织、胸壁和肿瘤的患者特定生物力学模型。在模拟术中设置中，使用激光测距扫描仪扫描乳房表面，并使用跟踪超声扫描胸壁和肿瘤。刚性配准结合新型非刚性配准常规用于对准术前和术中患者乳房和肿瘤。配准框架由乳房表面数据（可见表面的激光范围扫描）、超声胸壁表面和MR可见基准驱动。通过跟踪超声进行的肿瘤定位仅用于评价术前MR肿瘤轮廓与患者物理空间对齐的保真度。使用跟踪超声来识别次表面特征，以约束我们的非刚性配准方法并评估我们框架的保真度，这使得这项工作独一无二。作为对实现这种仰卧图像引导方法的初步调查，对两名患者进行了分析。使用粘性MR可见基准标记对两名计划进行乳房肿瘤切除术的患者进行初始刚性配准。对于患者1，刚性配准导致均方根基准配准误差（FRE）为7.5 mm，并且使用跟踪超声成像可视化的术中肿瘤质心与配准的术前MR对应物之间的差异为6.5 mm。非刚性校正导致FRE降低至2.9 mm，肿瘤质心差异降低至5.5 mm。对于患者2，刚性配准导致8.8 mm的FRE和12.5 mm的3D肿瘤质心差。对患者2进行非刚性校正后，FRE减小到7.4 mm，3D肿瘤质心差减小到5.3 mm。使用我们的原型图像引导手术平台，我们能够以临床相关的准确性将术中数据与术前患者特异性模型对准;即，肿瘤质心定位约为5.3-5.5 mm。
Unfortunately, the current re-excision rates for breast conserving surgeries due to positive margins average 20–40%. The high re-excision rates arise from difficulty in localizing tumor boundaries intraoperatively and lack of real-time information on the presence of residual disease. The work presented here introduces the use of supine magnetic resonance (MR) images, digitization technology, and bio-mechanical models to investigate the capability of using an image guidance system to localize tumors intraoperatively. Preoperative supine MR images were used to create patient-specific biomechanical models of the breast tissue, chest wall, and tumor. In a mock intraoperative setup, a laser range scanner was used to digitize the breast surface and tracked ultrasound was used to digitize the chest wall and tumor. Rigid registration combined with a novel non-rigid registration routine was used to align the preoperative and intraoperative patient breast and tumor. The registra tion framework is driven by breast surface data (laser range scan of visible surface), ultrasound chest wall surface, and MR-visible fiducials. Tumor localizations by tracked ultra-sound were only used to evaluate the fidelity of aligning preoperative MR tumor contours to physical patient space. The use of tracked ultrasound to digitize subsurface features to constrain our nonrigid registration approach and to assess the fidelity of our framework makes this work unique. Two patient subjects were analyzed as a preliminary investigation toward the realization of this supine image-guided approach. An initial rigid registration was performed using adhesive MR-visible fiducial markers for two patients scheduled for a lumpectomy. For patient 1, the rigid registration resulted in a root-mean-square fiducial registration error (FRE) of 7.5 mm and the difference between the intraoperative tumor centroid as visualized with tracked ultrasound imaging and the registered preoperative MR counterpart was 6.5 mm. Nonrigid correction resulted in a decrease in FRE to 2.9 mm and tumor centroid difference to 5.5 mm. For patient 2, rigid registration resulted in a FRE of 8.8 mm and a 3D tumor centroid difference of 12.5 mm. Following nonrigid correction for patient 2, the FRE was reduced to 7.4 mm and the 3D tumor centroid difference was reduced to 5.3 mm. Using our prototype image-guided surgery platform, we were able to align intraoperative data with preoperative patient-specific models with clinically relevant accuracy; i.e., tumor centroid localizations of approximately 5.3–5.5 mm.