New Technologies for Real-Time MRI-Guided Robotic-Assisted Abdominal Interventions

项目总结 腹癌是全世界发病率和死亡率的毁灭性原因。例如，肝细胞 癌症(HCC)的五年存活率不到20%，是癌症上升最快的原因- 在美国，早期和准确的诊断至关重要，因为通过手术治愈是可行的 切除和/或局部消融。与手术相比，局灶性消融减少了住院时间，增加了 保护周围正常组织，减少与治疗相关的发病率。然而，焦点 消融在适用性和有效性方面仍面临严重限制，原因是图像引导和治疗不足 目前的方法提供了程序上的准确性。因此，迫切需要建立新的 提高腹部肿瘤诊断和治疗水平的微创介入治疗。 传统的腹部干预依赖于超声和/或计算机断层扫描(CT)的图像引导， 这可能无法提供对癌变病变的充分可视化。此外，CT利用电离辐射 并且不能在整个干预过程中用于实时成像。磁共振成像(MRI)有 使其成为腹部干预实时指导的关键优势：这是最好的和/或唯一的方法 以可视化的肝细胞癌和几种类型的腹癌，没有电离辐射，并有可能真正- 对不断运动的腹部器官的时间成像。然而，当前的实时核磁共振成像存在以下问题 在图像质量、时间延迟和在跟踪设备和组织目标方面的困难 动议。此外，核磁共振扫描仪狭窄的物理空间严重阻碍了医生接触 在成像过程中，患者在扫描仪内。因此，目前的MRI引导的干预需要繁琐 影响准确性和效率的工作流。 该方案的目标是克服这些挑战，并实现实时MRI引导的腹部 干预措施。跨学科研究团队将利用(1)实时核磁共振和 计算机辅助指导方法，(2)与MRI兼容的机器人，以及(3)计算机辅助反馈控制 创建一种新的实时核磁共振引导机器人系统的方法和交互用户界面。系统将 在可编程动态组织模体和活体猪肝脏模型中进行评估，以实现安全、准确、 以及在移动目标中有效地放置针头--这是所有腹部干预的基础。这是一项新的 机器人系统将实现下一代实时核磁共振引导的干预，这将对 肝肿瘤和腹癌患者的诊断和治疗。

PROJECT SUMMARY Abdominal cancers are a devastating cause of morbidity and mortality worldwide. For example, hepatocellular carcinoma (HCC) has a grim five-year survival rate of less than 20% and is the fastest rising cause of cancer- related deaths in the U.S. Early and accurate diagnosis is crucial, as curative treatment is feasible by surgical resection and/or focal ablation. Compared to surgery, focal ablation reduces hospital stay, increases preservation of surrounding normal tissues, and decreases treatment-related morbidities. However, focal ablation still faces critical limitations in applicability and effectiveness due to inadequate image guidance and procedural accuracy provided by current approaches. Consequently, there is a pressing need to establish new minimally invasive interventions to improve the diagnosis and treatment of abdominal cancers. Conventional abdominal interventions rely on image guidance by ultrasound and/or computed tomography (CT), which can fail to provide sufficient visualization of the cancerous lesions. In addition, CT utilizes ionizing radiation and cannot be used for real-time imaging throughout an intervention. Magnetic resonance imaging (MRI) has crucial advantages that make it ideal for real-time guidance of abdominal interventions: it is the best and/or only way to visualize HCC and several types of abdominal cancers, has no ionizing radiation, and has the potential for real- time imaging of abdominal organs that are constantly in motion. However, current real-time MRI suffers from compromises in image quality, time latency, and difficulties in tracking the devices and tissue targets during motion. Furthermore, the narrow physical space of MRI scanners severely impedes the physician’s access to the patient inside the scanner during imaging. As a result, current MRI-guided interventions require cumbersome workflows that hamper the accuracy and efficiency. The objective of this proposal is to overcome these challenges and enable real-time MRI-guided abdominal interventions. The interdisciplinary research team will leverage synergistic innovations in (1) real-time MRI and computer-aided guidance methods, (2) MRI-compatible robotics, and (3) computer-aided feedback control methods and interactive user interfaces to create a new real-time MRI-guided robotic system. The system will be evaluated in programmable dynamic tissue phantoms and in vivo pig liver models to achieve safe, accurate, and efficient needle placement in moving targets – the foundation for all abdominal interventions. This new robotic system will enable next-generation real-time MRI-guided interventions that can positively impact the diagnosis and treatment of patients with liver tumors and abdominal cancers.