Improved Targeting in Minimally Invasive Image-Guided Radio Frequency Ablation

描述(申请人提供)：这是一份R03拨款申请，为期两年，用于应用新颖的先进图像分析技术，并引入将在CT引导的射频消融过程中改进射频电极放置的技术。这个应用程序符合R03的条件，因为它是一个小型研究项目，可以在有限的资源下在短时间内进行，因为只会分析回溯的数据。从这项研究中获得的知识将确立将术前高分辨率图像与术中图像配准的可行性。术前获取的数据能够准确地识别肿瘤边缘，并勾勒出需要保存的关键组织。然而，目前，术前和术中数据的比对是由介入肿瘤学家在心理上完成的。临床研究表明，小于3厘米的肿瘤通常完全可以用射频消融治疗。然而，考虑到治疗的肿瘤体积较小，腹部解剖结构的非刚性运动可能会造成准确评估射频电极放置的困难。目前还没有在射频消融过程中融合术前和术中数据的方法。在这项初步研究中，将对BWH现有的数据进行回顾分析。程序前和程序内的图像将同时进行刚性和非刚性配准。我们将评估是否可以将术前图像配准为术中图像，并更好地确定靶向时间。由于术后图像不含可见肿瘤，肿瘤是否得到完全治疗，评估往往难以确定。我们还旨在通过配准手术前和手术后的图像来改善治疗结果的量化评估。成功与否将取决于所获得的配准结果的准确性和稳健性。在评估结果时，将采用数学方法和放射科医生对结果的目测检查。这项提议将通过开发和评估关键技术来增强图像引导射频消融期间的导航，从而使公众健康受益。在整个手术过程中显示肿瘤和肿瘤边缘的能力将使介入放射科医生能够更准确地实现整个肿瘤的射频电极放置和凝固性坏死，而不会出现意外的部位影响。

DESCRIPTION (provided by applicant): This is an R03 grant application for two years of funding to apply novel advanced image analysis techniques and introducing technology that would improve the placement of the Radiofrequency (RF) electrode during CT-guided guided RF ablation. This application qualifies as an R03 because it is a small research project that can be carried out in a short time with limited resources, as only retrospective data will be analyzed. The knowledge obtained from this study will establish the feasibility of registering pre-procedural high resolution images with intra-procedural images. Pre-procedural acquired data enables accurate identification of tumor margin and delineates critical tissue to preserve. However, currently, the alignment of pre- and intra-procedural data is done mentally by interventional oncologists. Clinical studies have shown that tumors smaller than 3 cm are often treated completely with RF ablation. Nevertheless, non-rigid motion of the abdominal anatomical structures can create difficulties in accurately assessing the RF electrode placement, considering the small size of treated tumors. Currently there is no method for fusing pre and intra-procedural data during RF ablations. A retrospective analysis of data available at BWH will be performed in this pilot study. Pre- and intra- procedural images will be both rigid and non-rigid registered. We will evaluate if pre-procedural images can be registered to intra-procedural images and delineate better the time for targeting. Since post-procedural images do not contain visible tumor, whether the tumor was completely treated, the assessment is often difficult to determine. We aim also improving the quantitative assessment of the treatment outcome by registration of pre-and post-procedural images. The success will be determined by the accuracy and robustness of the registration results obtained. Both mathematical methods and visual inspection by radiologists of results will be employed in assessing the results. This proposal will benefit public health by developing and assessing key technologies to enable enhanced navigation during the image guided radiofrequency ablation. The capacity to visualize the tumor and tumor margin throughout the procedure will better enable the interventional radiologists to achieve accurate RF electrode placement and coagulation necrosis for the entire tumor mass, without unexpected site effects.