Multimodal Registration of the Brain's Cortical Surface

描述(申请人提供)：在今年确诊的20,500人中，有12,740人死于中枢神经系统癌症，其中大约85%-90%的患者患有脑瘤。五年存活率约为34-37%，尽管在过去20年中增加了20%。根据国家癌症研究所的说法，手术切除是大多数脑肿瘤的推荐治疗方法，目标是在保留神经功能的同时尽可能完整地切除肿瘤。就国家神经疾病和中风研究所的使命而言，更彻底的切除通过恢复功能、延长生命和提高生活质量来减轻神经疾病的负担。在手术治疗方面，将患者暴露在手术室(OR)内的大脑与术前获得的神经解剖图像联系起来的视觉显示已变得司空见惯。更具体地说，外科医生可以使用笔状的触控笔指向患者脑组织的特定部分，并通过交互式显示来查看该组织在神经解剖图像上的位置。这一过程的一个不利之处是，患者的大脑因常见的手术操作而变形。结果，图像和患者的物理大脑之间的对准受到损害，可能会接踵而至的手术错误。在最近的工作中，激光距离扫描(LRS)技术已经被证明既可以改善皮质表面的对准，又可以在手术中测量大脑变形。在这一应用中，LRS技术的使用将与计算机模型相结合，以纠正手术中由变形引起的对准偏差。要检验的假设是，计算机模型、术中环境的激光距离数据和跟踪触针数字化技术可以结合在一起，有效地补偿图像引导的脑肿瘤手术中的变形。研究这一假设的具体目的包括：(1)可定位于无菌领域的综合数字化平台，(2)基于数字化平台收集的数据补偿变形的计算机算法，(3)可处理数据并将数据可视化地呈现给外科医生以供反馈的OR计算节点，以及(4)验证该方法的一系列临床研究。该应用程序中的工作将是第一个完全实现图像引导手术的矫正系统。该策略特别创新，通过使用预计算和直接模拟来生成稳健、准确和快速的补偿方法。考虑到验证的困难，我们还生成了一个由三个组件组成的验证方法，当它们结合在一起时，将提供对这些技术的良好评估。就这项工作的重要性而言，在很大程度上，影像引导手术在软组织器官外科切除中的使用主要局限于颅脑环境。通过这里提出的变形的解决方案，将图像引导手术转换到其他软组织器官的能力成为可能。此外，与术中成像方法(例如MR)相比，这里的方法也是便宜的，并且是可扩展的，即能够广泛采用。这个应用程序专注于产生图像制导的下一次发展。公共卫生意义：在今年确诊的20,500人中，有12,740人死于中枢神经系统癌症，其中大约85%-90%的患者患有脑瘤。根据国家癌症研究所的说法，手术切除是大多数脑肿瘤的推荐治疗方法，目标是在保留神经功能的同时尽可能完整地切除肿瘤。更完整的切除可以恢复功能，延长生命，提高生活质量。这个项目的目标是帮助外科医生对脑肿瘤进行更彻底的切除。另一个重要的方面是，我们正在引进的技术相对便宜，适合全国各地的医疗中心广泛采用。

DESCRIPTION (provided by applicant): Of the 20,500 people diagnosed, and the 12,740 deaths from cancer of the central nervous system this year, approximately 85-90% of these patients are afflicted with brain tumors. The 5-year survival rate is approximately 34-37% despite an increase by 20% over the past 20 years. According to the National Cancer Institute surgical removal is the recommended treatment for most brain tumors with the goal of the most complete resection possible while preserving neurological function. With respect to the mission of the National Institute for Neurological Disorders and Stroke, more complete resection reduces the burden of neurological disease by restoring function, extending life, and improving the quality of that life. With respect to surgical therapy, the deployment of visual displays that relate the patient's exposed brain within the operating room (OR) to the pre-operatively acquired neuroanatomical images has become commonplace. More specifically, surgeon's can use a pen-like stylus to point at a specific piece of the patient's brain tissue and see where that tissue resides on the neuroanatomical images as facilitated by an interactive display. One detriment to this process is when the patient's brain deforms due to common surgical manipulations. As a result, the alignment between images and the patient's physical brain becomes compromised and surgical error could ensue. In recent work, laser range scanning (LRS) technology has been demonstrated to both improve the alignment of the cortical surface and measure brain deformations during surgery. In this application, the use of LRS technology will be extended in conjunction with computer models to correct the deformation-induced misalignment during surgery. The hypothesis to be tested is that computer models, laser range data of the intra-operative environment, and tracked stylus digitization technology can be combined to effectively compensate for deformation during image-guided brain tumor surgery. The specific aims to investigate this hypothesis involve the development of: (1) a comprehensive digitization platform that can be positioned in the sterile field, (2) a computer algorithm to compensate for deformations based on data collected with digitization platform, (3) an OR compute node that can process data and present the data visually to the surgeon for feedback, and (4) a series of clinical studies to validate the approach. The work in this application will be the first fully realized correction system for image-guided surgery. The strategy is particularly innovative by using both pre-computation and direct simulation to generate a robust, accurate, and fast approach to compensation. Given the difficulty in validation, we have also generated a 3-component approach to validation, which when take together, will provide a good assessment of the techniques. With respect to the importance of this work, in large part, the use of image-guided surgery for surgical resection in soft-tissue organs has been confined primarily to the cranial environment. With the resolution of deformations as proposed herein, the ability to translate image-guided surgery to other soft-tissue organs becomes possible. Furthermore, the approaches herein are also inexpensive when compared to intra-operative imaging methods (e.g. MR), and scalable, i.e. capable of widespread adoption. This application is focused at producing the next evolution in image guidance. PUBLIC HEALTH RELEVANCE: Of the 20,500 people diagnosed, and the 12,740 deaths from cancer of the central nervous system this year, approximately 85-90% of these patients are afflicted with brain tumors. According to the National Cancer Institute surgical removal is the recommended treatment for most brain tumors with the goal of the most complete resection possible while preserving neurological function. More complete resection restores function, extends life, and improves the quality of that life. The goal of this project is to assist the surgeon in producing a more complete resection of brain tumors. The other important aspect is the technology we are introducing is relatively inexpensive and is amenable to widespread adoption by medical centers all across the country.