Clinical Application of Image Guided Liver Surgery

肝脏肿瘤的外科治疗是在直接触诊和目测的基础上切除或消融受累组织，有时辅助术中超声(IOUS)。交互式图像引导手术(IIGS)是一种新技术，它在断层图像(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/或病理标志物识别精确的工作位置。因此，三维空间中的准确位置可以在整个手术过程中共享和关联，并显著增强手术导航。工程概念和数学原理将用于开发一种创新的肝脏外科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、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用于手术室的系统。这笔赠款的R21阶段的具体目标是：1)开发一种自动的三维肝脏分割方法，以便在图像引导的肝脏手术下进行准确的配准；2)开发用于图像引导的肝脏手术的超声跟踪技术；3)充分控制肝脏运动，并开发结合了通过激光扫描仪实时获得的肝脏表面数据的精确配准算法。这笔赠款的R33阶段的重点将放在该系统的临床应用上，最终目标是图像引导下的肿瘤消融和切除。该项目第二至第四年提出的具体目标是：1)在图像引导的肝脏手术中加强稳健的肝脏分割和表面配准的自动方法；2)在接受标准肝切除的患者中利用图像引导确认系统的肿瘤靶向准确性；3)确定图像引导消融在接受肝切除手术的患者中的有效性；4)使用图像引导消融来准确地靶向和摧毁原发和转移性肝肿瘤，并在肝切除术中提供手术导航。我们相信，IIGS将显著改进目前正在进行的临床手术，并将为消融和切除手术提供准确的肿瘤定位。这项技术还可能使目前在非常有限的情况下进行的肝脏肿瘤的微创治疗成为可能。这项工作还将作为肝胆外科和肝移植系医学博士William Chapman和生物医学工程系医学博士Robert Gloway Ph.D.以及范德比尔特技术指导治疗中心的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.