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

描述(申请人提供)：锥束CT(CBCT)为影像引导介入提供了一种重要的新方法。它在可移动的C臂上的实施为开发高性能的术中成像和引导系统提供了机会，并调查了在具有挑战性的介入任务中对手术性能的好处。在头颈部(H&N)手术中，在没有术中成像的情况下，关键结构(如视神经、颈动脉和脑)复杂环境中的浸润性疾病对手术效果构成了重大挑战。虽然传统的图像引导手术(IGS)使用相对于术前图像的实时跟踪和导航提供了重要的进步，但其价值在很大程度上局限于在僵硬(非变形)骨骼解剖的背景下切除骨肿瘤。广泛的H&N手术--尤其是那些针对治疗过程中可能发生变形的软组织病变(如眼眶和颅内结构的突出)的手术--需要术中成像才能充分发挥IGS的优势。我们假设，术中CBCT提供亚毫米的3D空间分辨率和软组织可见性，将使靶区消融的手术效果最大化，将关键结构的并发症降至最低，并将IGS的适用性扩展到H&N介入的所有范围。我们提出了基于C-ARM CBCT的高性能图像制导系统的开发、表征和部署如下：1)开发基于C-ARM CBCT、实时跟踪和三维可变形图像配准的全集成手术导航系统；定量评估具有挑战性的介入性任务的手术效果，包括筛窦消融、经蝶入路至中枢神经系统和颅底病变切除；在研究方案下的患者研究中，包括术中多模式CBCT和MRI，研究系统在临床前部署中的性能。基于术中CB CT的高性能IGS可提供：i)改善手术性能(在消融具有挑战性的靶点时最大限度地提高敏感度和特异度)；将外科手术的适用范围扩大到传统上不能手术的病例；以及支持开发新的手术疗法(例如，机器人辅助手术、光动力疗法和使用化学或生物制剂的精确靶向)，这些疗法需要术中成像提供高度的几何精度。

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.