A Needle Guidance System for Hepatic Tumor Ablation That Fuses Real-Time Ultrasou

融合实时超声的肝肿瘤消融针​​引导系统

• 批准号: 8314235
• 负责人: Sharif Razzaque
• 金额: $ 65.28万
• 依托单位: INNEROPTIC TECHNOLOGY, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8314235
• 关键词: Abdomen; Ablation; Accounting; Address; Algorithms; Anatomy; Appearance; Area; Biopsy; Blood Vessels; Blood flow; Breathing; Caring; Cognitive; Data; Data Set; Development; Devices; Diagnostic; Drug Delivery Systems; Effectiveness; Evaluation; Excision; FDA approved; Feedback; Future; Hepatic; Human; Image; Imagery; Injury; Intervention; Lead; Left; Lesion; Life; Liquid substance; Liver; Liver neoplasms; Location; Magnetic Resonance Imaging; Measures; Medical center; Methods; Metric; Modality; Modeling; Monitor; Motion; Needle biopsy procedure; Needles; Operating Rooms; Operative Surgical Procedures; Organ; Outcome; Participant; Pathology; Patients; Phase; Physicians; Positioning Attribute; Probability; Procedures; Reporting; Research Personnel; Resolution; Risk; Running; Scanning; Shapes; Space Perception; Staging; Sterility; Structure; Surgeon; System; Techniques; Technology; Testing; Time; Tissues; Transducers; Ultrasonic Transducer; Ultrasonography; Update; Visual; X-Ray Computed Tomography; distraction; image registration; imaging modality; improved; innovation; microwave electromagnetic radiation; new technology; novel; operation; radiologist; soft tissue; standard of care; stereoscopic; success; tumor

DESCRIPTION (provided by applicant): We propose to develop an operating-room-ready system for needle guidance in soft tissue, which fuses intra- operative ultrasound and pre-operative X-ray computed tomography (CT) data by combining two novel technologies: 1) a radically different way of visualizing and interacting with the fused ultrasound and CT images, which we call Spotlight"; and 2) an innovative algorithm that automatically and continuously performs ultrasound-to-CT registration. Conventional image guidance during surgery has several problems. For example, intra-operative ultrasound guidance gives real-time feedback about the patient's anatomy, but some tumors are only visible in CT, which offers a higher resolution (and a larger 3D volume). On the other hand, a CT scan of soft tissue becomes obsolete as soon as the organs move by even a small amount, for example, due to breathing. The two modalities are usually viewed on separate monitors, which amplifies another problem: the appearance of anatomical features is usually different in ultrasound and in CT, and there is no visual correspondence between them. Furthermore, the pre-operative annotations of the CT-indicating the locations of tumors or lesions-cannot be seen in the context of the ultrasound. In this proposal, we address these problems by developing a guidance system that: 1) registers and fuses pre- operative CT with intra-operative ultrasound; 2) dynamically volume-renders the CT scan and its pre-operative annotations in such a way as to highlight the most relevant portions of the dataset given the position of the ultrasound transducer and needle, while still indicating the remaining portions of the dataset for context; and 3) allows for intra-operative annotation to both modalities. To this end, we propose to refine and evaluate Spotlight iteratively, using phantoms and human patients. We also propose to develop a novel ultrasound-to- CT registration technique, to make it suitable for real-time operation during interventions, and to evaluate it, integrated with Spotlight, on human patients. For the evaluation, we will initially deploy the system in open surgical microwave ablation of liver tumors, but the technology is not limited to that specific intervention. In the future, it would be adapted to any procedure in which needles, ultrasound and pre-operative scans such as CT or MRI are employed. Our proposed system has potential to dramatically improve the utility of CT in the operating room, increasing the likelihood of an effective, efficient and complete intervention and improved patient outcome. PUBLIC HEALTH RELEVANCE: We propose to develop a system that registers and visualizes pre-operative CT and intra-operative ultrasound images during surgical interventions. This system provides to the surgeon a combination of the two modalities' benefits while negating each other's shortcomings, allowing him to more effectively and efficiently perform the intervention. The surgeon can also make intra-operative annotations to both modalities with our system, so that he can mark all tumors that he intends to treat. Patient benefits of such a system will include shorter operating time, reduced risk of injury, and increased probability of complete tumor removal, in a variety of interventions, such as ablation, biopsy, and drug delivery.

描述（由申请人提供）：我们提出开发一种用于软组织中的针引导的手术室就绪系统，其通过组合两种新技术来融合术中超声和术前X射线计算机断层摄影（CT）数据：1）可视化并与融合的超声和CT图像交互的完全不同的方式，我们称之为“聚光灯”;以及2）自动和连续执行超声到CT配准的创新算法。手术期间的常规图像引导具有若干问题。例如，术中超声引导提供有关患者解剖结构的实时反馈，但一些肿瘤仅在CT中可见，这提供了更高的分辨率（和更大的3D体积）。另一方面，只要器官移动很小的量，例如，由于呼吸，软组织的CT扫描就会过时。这两种模式通常在单独的监视器上查看，这放大了另一个问题：超声和CT中解剖特征的外观通常不同，并且它们之间没有视觉对应关系。此外，CT的术前注释-指示肿瘤或病变的位置-在超声的背景下无法看到。在该提议中，我们通过开发一种引导系统来解决这些问题，该引导系统：1）将术前CT与术中超声配准并融合; 2）以这样的方式动态地体积渲染CT扫描及其术前注释，即在给定超声换能器和针的位置的情况下突出显示数据集的最相关部分，同时仍然指示数据集的剩余部分用于上下文;以及3）允许对两种模态进行术中注释。为此，我们建议使用幻影和人类患者迭代地改进和评估Spotlight。我们还建议开发一种新的超声到CT配准技术，使其适用于干预期间的实时操作，并结合Spotlight对人类患者进行评估。为了进行评价，我们将首先在肝脏肿瘤的开放式外科微波消融中部署该系统，但该技术并不限于该特定干预。在未来， 适用于任何使用针、超声和术前扫描（如CT或MRI）的手术。我们提出的系统有可能大大提高CT在手术室中的实用性，增加有效，高效和完整干预的可能性，并改善患者的预后。 公共卫生相关性：我们建议开发一个系统，注册和可视化术前CT和术中超声图像在手术干预。该系统为外科医生提供了两种模式的优点的组合，同时消除了彼此的缺点，使他能够更有效地进行干预。外科医生还可以使用我们的系统对两种模式进行术中注释，以便他可以标记他打算治疗的所有肿瘤。这种系统的患者受益将包括缩短手术时间，降低损伤风险，并增加在各种干预中完全切除肿瘤的可能性，例如消融，活检和药物输送。