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

描述（由申请人提供）：锥形束CT （CBCT）为图像引导干预提供了一种重要的新方式。它在移动c型臂上的应用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对手术性能的益处。在头颈部（H&N）手术中，在缺乏术中成像的情况下，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仅限于在刚性（非变形）骨骼解剖背景下的骨肿瘤切除。广泛的H&N手术-特别是针对在治疗过程中可能发生变形的软组织病变（例如，眼眶和颅内结构突出）-需要术中成像才能充分利用IGS。我们假设术中CBCT提供低于毫米的三维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效果，最大限度地减少对关键结构的并发症，并扩大IGS在H&N全范围干预中的适用性。我们提出基于c臂CBCT的高性能图像制导系统的开发、表征和部署如下：开发基于c臂CBCT、实时跟踪和三维可变形图像配准的全集成手术引导系统；2.） 定量评估具有挑战性的介入手术的益处，包括筛窦消融、经蝶窦入路进入中枢神经系统和颅底病变切除；和3)。根据研究方案，包括多模态术中CBCT和MRI，调查系统在临床前部署在患者研究中的性能。基于术中CB CT的高性能IGS提供：1)提高手术性能（最大限度地提高对挑战性目标消融的敏感性和特异性）；Ii .)将手术的应用范围扩大到传统上无法手术的病例；iii.)支持新型外科治疗方法的发展（例如，机器人辅助手术、光动力治疗和使用化学或生物制剂的精确靶向），这些方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.