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

描述（由申请人提供）：我们建议开发一个手术室准备好的软组织针引导系统，该系统融合术中超声和术前x射线计算机断层扫描（CT）数据，通过结合两种新技术：1)一种完全不同的可视化方式，并与融合的超声和CT图像交互，我们称之为“聚光灯”；2)一种创新的算法，可以自动连续地进行超声到ct的配准。手术中传统的图像引导存在一些问题。例如，术中超声引导可以实时反馈患者的解剖结构，但有些肿瘤只能在CT上看到，这提供了更高的分辨率（和更大的3D体积）。另一方面，只要器官有微小的移动，比如呼吸，软组织的CT扫描就会过时。这两种模式通常在不同的监视器上观察，这放大了另一个问题：超声和CT的解剖特征外观通常不同，它们之间没有视觉上的对应关系。此外，术前ct的注释-指示肿瘤或病变的位置-不能在超声的背景下看到。在本提案中，我们通过开发一种引导系统来解决这些问题：1)术前CT与术中超声的登记和融合；2)动态体积渲染CT扫描及其术前注释，以便在给定超声换能器和针头位置的情况下突出显示数据集中最相关的部分，同时仍然显示数据集的其余部分；3)允许术中对两种模式进行注释。为此，我们建议使用幻影和人类患者对Spotlight进行迭代改进和评估。我们还建议开发一种新的超声- 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。为了评估，我们将首先将该系统部署在开放手术微波消融肝脏肿瘤中，但该技术并不局限于该特定干预。在未来，它将是

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.