High-Performance Cone-Beam CT Guidance of Head and Neck Surgery

描述（由申请人提供）：锥形束CT（CBCT）为图像引导介入提供了一种重要的新模式。其在移动的C形臂上的实现为开发高性能术中成像和引导系统提供了机会，并研究了在具有挑战性的介入任务中手术性能的受益。在头颈部（H&N）手术中，在关键结构（例如，视神经、颈动脉和脑）在缺乏术中成像的情况下对手术性能提出了重大挑战。虽然使用相对于术前图像的实时跟踪和导航的传统图像引导手术（IGS）提供了重要的进步，但其价值在很大程度上限于在刚性（非变形）骨骼解剖结构的背景下切除骨肿瘤。广泛的H&N手术-特别是针对治疗过程中可能变形的软组织病变的手术（例如，眼眶和颅内结构疝）-需要术中成像以获得IGS的全部益处。我们假设，术中CBCT提供亚毫米级3D空间分辨率和软组织可见性，将最大限度地提高靶消融的手术性能，最大限度地减少关键结构的并发症，并将IGS的适用性扩展到整个H&N干预范围。我们建议开发、表征和部署基于C形臂CBCT的高性能图像引导系统，如下所示：1.开发基于C形臂CBCT、实时跟踪和3D可变形图像配准的完全集成的手术引导系统; 2.）定量评估在具有挑战性的介入任务中对手术性能的受益，包括筛窦消融、经蝶入路至CNS和颅底病变切除;以及3.）根据研究方案，在患者研究中调查临床前部署的系统性能，包括多模态术中CBCT和MRI。基于术中CB CT的高性能IGS艾德提供：i.）改善手术性能（最大化消融挑战性目标的灵敏度和特异性）; ii.）将手术的应用扩展到常规上不能手术的病例;以及iii.）支持新型外科治疗的发展（例如，机器人辅助手术、光动力学治疗和使用化学或生物制剂的精确靶向），其需要由术中成像提供的高度几何精度。

DESCRIPTION (provided by applicant): Cone-beam CT (CBCT) offers an important new modality for image-guided interventions. Its implementation on a mobile C-arm presents an opportunity to develop a high-performance intraoperative imaging and guidance system and investigate the benefits to surgical performance in challenging interventional tasks. In head and neck (H&N) surgery, infiltrative disease within a complex environment of critical structures (e.g., the optic nerves, carotid arteries and brain) poses a major challenge to surgical performance in the absence of intraoperative imaging. While conventional image-guided surgery (IGS) using real-time tracking and navigation relative to preoperative images has offered an important advance, its value is largely limited to resection of bony neoplasms in the context of rigid (non-deforming) skeletal anatomy. A broad spectrum of H&N surgeries - particularly those targeting soft-tissue lesions with deformation likely in the course of therapy (e.g., herniation of orbital and intracranial structures) - requires intraoperative imaging to reap the full benefit of IGS. We hypothesize that intraoperative CBCT offering sub-mm 3D spatial resolution and soft-tissue visibility will maximize surgical performance in target ablation, minimize complications to critical structures, and extend the applicability of IGS across the full range of H&N interventions. We propose to develop, characterize, and deploy a high-performance image guidance system based on C-arm CBCT as follows: 1.) Develop a fully integrated surgical guidance system based on C-arm CBCT, realtime tracking, and 3D deformable image registration; 2.) Quantitatively evaluate the benefits to surgical performance in challenging interventional tasks, including ethmoid sinus ablation, trans-sphenoid approach to the CNS, and skull base lesion excision; and 3.) Investigate system performance in pre-clinical deployment in patient studies under research protocol, including multi-modality intraoperative CBCT and MRI. High-performance IGS bas ed on intraoperative CB CT offers to: i.) improve surgical performance (maximize sensitivity and specificity in the ablation of challenging targets); ii.) expand the application of surgery to cases that would be conventionally inoperable; and iii.) support the development of novel surgical therapeutics (e.g., robot-assisted surgery, photodynamic therapy, and precise targeting using chemical or biological agents) that require a high degree of geometric precision provided by intraoperative imaging.