Lung nodule detection using 3D "visual palpation" via standard thoracoscopes

描述(申请人提供)：外科医生每年进行数以万计的手术来切除可疑的肺结节。在历史上，这需要一个开放的手术入路(开胸手术)，通过一个大的胸壁切开。在过去的10-15年中，微创手术(MIS)方法在腹部和胸部手术中变得越来越常见，为患者和医疗保健经济带来了显著的好处。然而，开放式手术的一个关键方面在管理信息系统中缺失：直接组织触诊(触摸)。虽然对于许多管理信息系统程序来说仅仅是一种滋扰，但由于很难发现肺表面下的结节，触觉反馈的丧失在胸腔镜肺活组织检查和切除中至关重要。这大大增加了漏诊结节的风险，并可能迫使外科医生放弃微创入路，打开胸腔，直接进行手动触诊。用于结节定位的术前技术已经取得了不同程度的成功，但都需要复杂的CT引导标记和笨重的术中仪器。工程师和科学家承担了在管理信息系统中恢复触诊的技术挑战。文献中描述了一系列设备，其中许多确实能够定位隐藏的结核。然而，值得注意的是，它们都不是通用的；它们很麻烦，可能会造成伤害，很难解释，而且价格昂贵。当外科医生在管理信息系统中需要寻找结节时，他们会扩大切口处，并将一根手指插入洞中。在这项研究项目中，我们将测试一种新的三维图像采集技术的能力，为肺表面下结节提供实时“视觉触诊”。该项目的最终目标是提供一种医用摄像机产品，与常见的手术室设备相结合，在管理信息系统中提供第一种实用、直观、即时和低成本的非接触触诊手段。最近开发的一种光电设备通过标准医学显微镜以视频帧速率获取高分辨率的3D地形数据。通过瞬间的气体喷射使肺表面向内偏转，位于表面以下的相对较硬的结节将改变覆盖组织的偏转，并被视为表面地形的像差。可以对3D地形数据进行分析和增强，以实时显示给外科医生，立即直观地揭示隐藏的结节。该项目的具体目标是(1)设计和制造连接到医用注气器的小型气体喷射探头，(2)编写用于地形分析的定制软件来标记隐藏结节造成的表面畸变，以及(3)在切除的动物和人类肺组织上测试该系统。 与公共卫生相关：切除癌性肺结节的手术挽救了生命。当结节生长在肺表面以下时，首选的微创手术方法可能会遗漏结节。本项目致力于开发和测试一种实用、直观、低成本的三维图像采集和分析解决方案，以解决隐藏的肺结节定位问题。

DESCRIPTION (provided by applicant): Surgeons perform tens of thousands of operations each year to resect suspicious lung nodules. Historically this necessitated an open surgical approach (thoracotomy) through a large chest wall incision. Over the last 10-15 years, minimally invasive surgical (MIS) approaches have become increasingly common in abdominal and thoracic surgery, with significant benefits accruing to both patients and healthcare economics. However, one key aspect of open surgery is missing in MIS: direct tissue palpation (touch). While a mere nuisance for many MIS procedures, the loss of tactile feedback is critically important during thoracoscopic lung biopsies and resections as it is very difficult to detect nodules beneath the lung surface. This significantly increases the risk of missing a nodule and can force the surgeon to abandon the minimally invasive approach, open the chest, and perform direct manual palpation. Pre-operative techniques to nodule localization have been used with varying success, but all involve complex CT-guided marking and bulky intraoperative instruments. Engineers and scientists have undertaken the technical challenge of restoring palpation in MIS. An array of devices is described in the literature, and many are indeed capable of locating hidden nodules. Significantly, however, none is in common use; they are cumbersome, potentially injurious, difficult to interpret, and expensive. When surgeons need to feel for nodules during MIS, they resort to enlarging the incision and sticking a finger into the hole. In this research project, we will test the ability of a new three-dimensional image acquisition technology to provide real-time "visual palpation" for sub-surface lung nodules. The eventual goal of the program is to offer a medical video camera product that, combined with common operating room equipment, provides the first practical, intuitive, immediate, and low cost means of non-touch palpation in MIS. A recently developed opto-electronic device acquires high-resolution 3D topographic data at video frame rates through standard medical scopes. By deflecting the lung surface inward with a momentary gas jet, relatively harder nodules located below the surface will alter the deflection of the overlying tissue and be seen as aberrations in the surface topography. The 3D topographic data can be analyzed and enhanced for display in real time to the surgeon, immediately and intuitively revealing the hidden nodule. The specific aims of this project are (1) design and fabricate a small gas-jet probe that connects to a medical insufflator, (2) write custom software for topographic analysis to tag surface aberations created by hidden nodules, and (3) test the system on excised animal and human lung tissue. PUBLIC HEALTH RELEVANCE: Surgery to remove cancerous lung nodules from saves lives. The preferred minimally invasive surgical approach can miss nodules when they have grown beneath the surface of the lung. This project strives to develop and test a practical, intuitive, and low-cost 3D image acquisition and analysis solution to the problem of locating hidden lung nodules.