Clinical Application of Image Guided Liver Surgery

肝肿瘤的手术治疗是通过基于直接触诊和视觉评估（有时辅以术中超声（IOUS））切除或消融受累组织来进行的。交互式图像引导手术（IIGS）是一项新技术，可在断层扫描图像（CT、MR、PET等）上显示当前手术位置，并允许根据先前识别的解剖和/或病理标志识别精确的工作位置。因此，在整个手术过程中可以共享和关联3D空间中的确切位置，并显著增强手术导航。工程概念和数学原理将用于开发用于肝脏手术的创新IIGS系统，包括从腹部CT扫描中有效分割肝脏的图像处理，将物理空间映射到图像空间的图像配准，以及集成硬件和软件开发，以创建可在手术室中使用的系统。该资助R21阶段的具体目标是：1）开发一种用于图像引导肝脏手术下精确配准的3D肝脏分割自动方法; 2）开发用于图像引导肝脏手术中特定用途的跟踪超声的技术; 3）精确控制肝脏运动并开发精确配准算法，结合激光扫描仪实时获得的肝脏表面数据。R33阶段的重点将是该系统的临床应用，最终目标是图像引导消融和肿瘤切除。该项目第2-4年的具体目标是：1）在图像引导肝脏手术期间加强用于稳健肝脏分割和表面配准的自动方法; 2）在接受标准肝脏切除术的患者中使用图像引导确认系统在肿瘤靶向方面的准确性; 3）确定接受肝脏切除术的患者中图像引导消融的有效性; 4）使用图像引导消融精确靶向和破坏原发性和转移性肝脏肿瘤，并在肝脏切除过程中提供手术导航。我们相信，IIGS将显着提高目前进行的临床程序，并将允许准确的肿瘤定位消融和切除手术。这项技术也可以允许微创治疗肝肿瘤，现在在非常有限的情况下进行。这项工作也将作为一个合作项目进行威廉查普曼，医学博士。肝胆外科和肝移植科的罗伯特·加洛韦博士，以及范德比尔特技术引导治疗中心的其他成员。

The surgical treatment of hepatic tumors is performed by removal or ablation of the involved tissue based on direct palpation and visual assessment sometimes aided with intraoperative ultrasound (IOUS). A new technology, interactive image-guided surgery (IIGS) displays current surgical positions on tomographic images (CT,MR,PET, etc) and permits the identification of precise working position with respect to previously identified anatomic and/or pathologic landmarks. Thus, the exact location in 3-D space can be shared and correlated throughout an operative procedure and significantly enhance surgical navigation. Engineering concepts and mathematical principles will be used in the development of an innovative IIGS system for hepatic surgery, including image processing for effective segmentation of the liver from abdominal CT scans, image registration to map physical space into image space, and integrated hardware and software development to create a system that can be used in th operating room. The specific aims of the R21 phase of this grant are: 1) Develop an automatic method for 3-D liver segmentation for accurate registration under image-guided hepatic surgery; 2) Develop techniques for track ultrasounds for specific use in image-guided hepatic surgery; 3) Adequately control hepatic motion and develop accurate registration algorithms incorporating liver surface data obtained in real-time with a laser scanner. The focus in the R33 phase of this grant will be on the clinical use of the system, with the eventual goal being image-guided ablation and resection of tumors. The specific aims proposed for years 2-4 of this project are: 1) Strengthen automatic methods for robust liver segmentation and surface registration during image-guided hepatic surgery; 2) Confirm system accuracy in tumor targeting using image-guidance in patients undergoing standard liver resection; 3) Determine th effectiveness of image-guided ablation in patients undergoing liver resection procedures; 4) Use image-guided ablation to accurately target and destroy primary and metastatic hepatic tumors and provide surgical navigation during hepatic resection. We believe that IIGS will significantly enhance currently performed clinical procedures and will permit accurate tumor localization for ablation and resection procedures. This technology also may permit minimally invasive treatment of liver tumors now performed in very limited circumstances. This work will also be carried out as a collaborative project between William Chapman, M.D. in the Department of Hepatobilliary Surgery and Liver Transplantation and Robert Galloway Ph.D., in the Department of Biomedical Engineering and other members within the center for Technology-Guided Therapy at Vanderbilt.