Interactive intraoperative imaging with cone beam CT

描述(由申请人提供)： 虽然图像引导手术(IGS)正在给耳鼻喉科和神经外科带来革命性的变化，但它的应用受到两个因素的限制。首先，将术前扫描(CT或MRI)与患者和手术室的坐标系共同配准的强制步骤繁琐、耗时，并引入了不准确的信息。其次，随着手术的进行，手术过程中的组织变化使得术前扫描的准确性越来越低。与成像引导手术系统完全集成以提供定期更新扫描的交互式术中成像工具将解决这两个问题，从而提高手术的准确性和简易性。然而，到目前为止提出的解决方案-术中超声波、MRI、移动式(但本质上是传统的)CT和具有3D功能的C-ARM-都失败了，因为它们要么难以使用，要么价格昂贵，图像质量差，要么与现有的手术室不兼容。我们建议开发一种紧凑的术中锥束CT成像工具，它将是高度交互的，并将允许外科医生执行定期更新扫描。拟议工作的长期目标是1)开发一个相对低成本和紧凑的硬件平台，适合于手术环境；2)开发新的技术，利用减少的视野采集，以减少的辐射剂量提供多次术中图像采集；3)进行初步性能测试，证明比传统的IGS系统更准确。对于这一阶段的工作，我们建议将重点放在使用缩小视野的术中扫描来更新感兴趣区域的具体目标上。这样的方案将大大减少辐射剂量，并将允许多次术中扫描。术中扫描本身将促进患者和IGS系统的准确登记，而额外的扫描可用于监测手术过程的进展并提供术后手术评估。

DESCRIPTION (provided by applicant): Although image guided surgery (IGS) is revolutionizing ENT- and neurosurgery, its utility is limited by two factors. First, the mandatory step of co-registering the preoperative scan (either CT or MRI) with the coordinate system of the patient and operating room is cumbersome, time consuming, and introduces inaccuracies. Second, tissue changes during surgery render the preoperative scans less and less accurate as the surgery progresses. An interactive intraoperative imaging tool that is fully integrated with the imageguided surgery system to provide periodic update scans would solve both problems and would thus increase the accuracy and ease of performing surgery. However, solutions proposed so far - intraoperative ultrasound, MRI, mobile (but in essence conventional) CT, and C-arms with 3D capabilities - have failed because they either are difficult to use, are expensive, produce poor images, or are incompatible with existing operating rooms. We propose to develop a compact intraoperative cone-beam CT imaging tool that will be highly interactive and will allow the surgeon to perform periodic update scans. The long-term aims of the proposed work are to 1) develop a relatively low-cost and compact hardware platform appropriate for an OR setting 2) develop novel techniques to provide multiple intraoperative image acquisitions at reduced radiation dose using reduced field of view acquisitions and 3) conduct initial performance testing demonstrating the improved accuracy over traditional IGS systems. For this Phase I effort we propose to focus on the specific aim of using reduced field-of-view, intraoperative scans to update a region of interest. Such a protocol will greatly reduce radiation dose and will allow for multiple intraoperative scans. Intraoperative scans themselves will facilitate accurate registration of the patient and the IGS system, whereas additional scans can be used to monitor the progression of a surgical procedure and to provide postoperative surgical assessment.