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

描述(申请人提供)：我们建议开发一种用于软组织穿刺针引导的手术室系统，该系统通过结合两种新技术融合术中超声和术前X射线计算机断层扫描(CT)数据：1)一种完全不同的可视化和与融合的超声和CT图像交互的方式，我们称之为Spotlight“；以及2)一种创新的算法，自动和连续地执行超声与CT的配准。手术中传统的图像引导存在几个问题。比方说，术中超声引导可以实时反馈患者的解剖结构，但一些肿瘤只能在CT上看到，CT分辨率更高(3D体积也更大)。另一方面，软组织的CT扫描一旦器官有微小的移动，例如由于呼吸，就会变得过时。这两种模式通常在不同的监视器上观看，这放大了另一个问题：解剖特征在超声和CT中的外观通常不同，它们之间没有视觉上的对应。此外，术前CT的注释--指示肿瘤或病变的位置--在超声的背景下是看不到的。在该建议中，我们通过开发一种引导系统来解决这些问题：1)将术前CT与术中超声进行配准和融合；2)动态地对CT扫描及其术前注释进行体积再现，以便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其余部分以供参考；以及3)允许术中对两种模式的注释。为此，我们建议使用幻影和人类患者反复改进和评估Spotlight。我们还建议开发一种新的超声-CT配准技术，使其适用于介入过程中的实时操作，并结合Spotlight在人类患者身上进行评估。为了进行评估，我们将初步将该系统部署在开放手术微波消融肝肿瘤中，但该技术并不局限于特定的干预。在未来，它将是 适用于任何使用针头、超声波和术前扫描(如CT或MRI)的程序。我们建议的系统有可能极大地提高CT在手术室中的实用性，增加有效、高效和完全干预的可能性，并改善患者的预后。

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.