3D Image Guided Endovascular Surgery

描述(申请人提供)：我们的长期目标是结合 最先进的三维(3D)图像制导，采用一种新的 血管分割和描述，以提高速度和减少 血管内操作困难的风险。一个特定的示例 困难的手术是经颈静脉肝内门体分流形成 (提示)，在此过程中，临床医生将针插入患者的肝脏 以便将一个静脉循环与另一个静脉循环连接起来。目标不能是 在肝脏穿刺术中可见，从而导致多次穿针和高 病人风险。我们的目标是为临床医生提供准确的3D图像指导 以提高速度和降低程序的风险。 方法包括：1)血管和肝脏的分割 术前获取的MR或CT数据，2)术中3D-2D配准 术中获取双平面数字血管的节段性三维血管 减影血管造影术(DSA)，3)快速、实时跟踪的发展 检测目标门静脉位置变化的方法 在手术过程中由于患者的呼吸或针头对肝脏的压力， 4)从双平面视图对TIPS针进行三维重建，从而将 3D血管系统坐标系内的针，5)整合 通过立体声、头跟踪显示和6)信息和可视化 四个阶段的评估过程。 根据这项提议制定的方法应立即受益于 小费。此外，这些方法通常适用于各种不同的 血管内手术，因此与数以百计的 数以千计的肿瘤或血管疾病患者接受血管内治疗 每年都要接受治疗。事实上，在这项提议下将制定的方法 有可能改变血管内手术的执行方式 遍及全身。

DESCRIPTION (provided by applicant): Our long-term goal is to combine state-of-the-art, three-dimensional (3D) image guidance with a new method of vascular segmentation and description in order to increase the speed and reduce the risk of difficult endovascular procedures. A specific example of a difficult procedure is transjugular intrahepatic portosystemic shunt formation (TIPS), during which the clinician inserts a needle through a patient's liver in order to connect one venous circulation with another. The target cannot be seen during liver puncture, thus leading to multiple needle passes and high patient risk. Our goal is to provide the clinician accurate, 3D image guidance in order to increase the speed and to decrease the risks of the procedure. Methods include: 1) Segmentation of the vasculature and liver from preoperatively acquired MR or CT data, 2) Intraoperative 3D-2D registration of the segmented 3D vessels with intraoperatively acquired biplane digital subtraction angiograms (DSA), 3) Development of fast, real-time tracking methods to detect changes in the position of the target portal vein resulting from patient respiration or needle pressure on the liver during the procedure, 4) 3D reconstruction of the TIPS needle from biplane views, thus placing the needle within the coordinate system of the 3D vasculature, 5) Integration of information and visualization by means of stereo, head-tracked display, and 6) A four-phase evaluation process. The methods developed under this proposal should be of immediate benefit to TIPS. Moreover, these methods are generally applicable to a wide variety of endovascular procedures, and are thus immediately relevant to the hundreds of thousands of patients with tumors or vascular disease that undergo endovascular treatment each year. Indeed, the methods to be developed under this proposal have the potential to change how endovascular procedures are performed throughout the body.