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

描述（由申请人提供）：锥束 CT (CBCT) 为图像引导干预提供了一种重要的新模式。它在移动 C 形臂上的实施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好处。在头颈 (H&N) 手术中，关键结构（例如视神经、颈动脉和大脑）的复杂环境中的浸润性疾病在缺乏术中成像的情况下对手术表现提出了重大挑战。虽然相对于术前图像使用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仅限于在刚性（不变形）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（例如眼眶和颅内结构突出）的手术，需要术中成像才能获得 IGS 的全部益处。我们假设术中 CBCT 提供亚毫米 3D 空间分辨率和软组织可视性将最大限度地提高目标消融的手术效果，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 干预措施中。我们建议开发、表征和部署基于 C 型臂 CBCT 的高性能图像引导系统，具体如下： 1.) 开发基于 C 型臂 CBCT、实时跟踪和 3D 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表现的益处，包括筛窦消融、经蝶骨入路中枢神经系统和颅底病变切除； 3.) 根据研究方案，调查患者研究中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 可以： i.) 提高手术性能（最大限度地提高挑战性目标消融的灵敏度和特异性）； ii.) 将手术的应用范围扩大到传统上无法手术的病例； iii.) 支持新型手术疗法的开发（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.