Clinical Application of Image Guided Liver Surgery

肝脏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））切除或消融相关组织来进行。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）上显示当前的手术位置，并允许相对于先前识别的解剖和/或病理标志识别精确的工作位置。因此，3D 空间中的确切位置可以在整个手术过程中共享和关联，并显着增强手术导航。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，包括用于从腹部 CT 扫描中有效分割肝脏的图像处理、用于将物理空间映射到图像空间的图像配准，以及用于创建可在手术室使用的系统的集成硬件和软件开发。该资助 R21 阶段的具体目标是： 1) 开发一种自动 3D 肝脏分割方法，以便在图像引导肝脏手术下进行准确配准； 2) 开发专门用于图像引导肝脏手术的跟踪超声技术； 3) 充分控制肝脏运动并开发精确的配准算法，结合使用激光扫描仪实时获得的肝脏表面数据。本次资助的 R33 阶段的重点将是该系统的临床使用，最终目标是图像引导的肿瘤消融和切除。该项目第 2-4 年提出的具体目标是： 1) 加强图像引导肝脏手术期间稳健肝脏分割和表面配准的自动方法； 2) 使用图像引导对接受标准肝切除术的患者确认肿瘤靶向的系统准确性； 3) 确定图像引导消融对接受肝切除手术的患者的有效性； 4) 使用图像引导消融准确瞄准并摧毁原发性和转移性肝脏肿瘤，并在肝切除过程中提供手术导航。我们相信 IIGS 将显着增强当前执行的临床手术，并将允许精确的肿瘤定位以进行消融和切除手术。这项技术还可能允许对目前在非常有限的情况下进行的肝脏肿瘤进行微创治疗。这项工作也将作为肝胆外科和肝移植系医学博士 William Chapman 和生物医学工程系 Robert Galloway 博士以及范德堡大学技术引导治疗中心其他成员之间的合作项目进行。

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.