Developing a Computerized Training Tool for Cryosurgery

描述（由申请人提供）：冷冻手术是通过冷冻破坏不需要的组织。尽管用于微创冷冻手术的装置和技术不断发展，但现代冷冻手术经常福尔斯不能最大化对目标区域的冷冻破坏，同时最小化对周围组织的冷冻损伤。在这里，最重要的困难之一-并且可能是要克服的不太直观的障碍-是冷冻区域的设计和生成，以与目标区域的形状和冷冻手术成功的既定标准充分相关。 该项目的重点是与冷冻手术最佳3D热场的规划和创建相关的医学培训和教育，以使外科医生，医学研究人员和临床仪器开发人员受益。 在这个项目中开发了一个计算机化的培训工具，其目标是缩短临床医生的学习曲线，减少实践时间，使案例研究的“假设”的情况下，并通过冷冻手术数据库，使过去的临床程序重新评估。虽然培训工具是为通用目的而设计的，但由于其高度的临床相关性，因此特别关注前列腺冷冻手术。 培训工具由三个模块组成：数据库，模拟器和导师;每个模块的开发代表了整体研究计划的一个特定目标。该数据库由三种类型的数据集组成：（i）从诸如超声的成像设备获得的体积图像，（ii）重建的3D目标区域模型，以及（iii）外科手术结果，取决于特定的外科手术参数，诸如冷冻探针的数量和类型、冷冻探针布局、冷冻探针冷冻能力以及所得到的温度场历史。模拟器模拟生物传热过程及其成像与标准的超声技术。基于模拟过程，导师交互式地指导学员确定最佳冷冻探针布局。导师可以用于规划未来的程序或重新评估过去的案例，同时进一步增加数据库的大小。 与NIH计划公告（PA）PAR-07-344一致-在“手术和虚拟工具”的特定领域-该项目集成了用于模拟手术过程的计算技术，包括冷冻特有的成像效果，以及临床治疗区域中的生物热传递过程的预测。重点放在冷冻手术数据库设计，数据检索，可视化和图形界面，其中数据库包括成像数据，目标区域的几何建模，冷冻设备的特点，和热场的历史。 该项目利用生物传热的快速模拟技术，以及最近开发的计算机化冷冻手术规划算法。通过将类似的方法应用于手术中的其他热模式，例如聚焦超声、微波、激光探针和其他多源加热元件，该培训工具的更广泛影响可能远远超过其在冷冻手术中的具体应用。

DESCRIPTION (provided by applicant): Cryosurgery is the destruction of undesired tissues by freezing. Despite the continuous development of devices and techniques for minimally invasive cryosurgery, modern cryosurgery frequently falls short of maximizing cryodestruction to the target region, while minimizing cryoinjury to the surrounding tissues. Here, one of the most significant difficulties - and probably the less intuitive obstacle to overcome - is the design and generation of a frozen region to adequately correlate with the shape of the target region and established criteria for cryosurgery success. This project focuses on medical training and education associated with planning and creation of the optimal 3D thermal field for cryosurgery, for the benefit of the surgeon, the medical researcher, and the clinical instrumentation developer. A computerized training tool is developed in this project, the objectives being to shorten the clinician's learning curve, reduce practice time, enable case studies of "what-if" scenarios, and to enable revaluation of past clinical procedures via a cryosurgery database. While the training tool is designed for general purposes, due to its high clinical relevancy, a particular attention is given to prostate cryosurgery. The training tool consists of three modules: database, simulator, and tutor; the development of each represents one specific aim of the overall research plan. The database consists of three types of datasets: (i) volumetric images obtained from an imaging device such as ultrasound, (ii) reconstructed 3D target region models, and (iii) surgical- procedure outcomes, subject to specific surgical parameters such as number and type of cryoprobes, cryoprobe layout, cryoprobe freezing capabilities, and the resulting temperature field history. The simulator imitates the bioheat transfer process and its imaging with a standard ultrasound technique. Based on the simulated process, the tutor interactively guides the trainee to identify the optimal cryoprobes layout. The tutor may be used for planning future procedures or reevaluation of past cases, while further increasing the size of the database. Consistent with NIH Program Announcement (PA) PAR-07-344 - in the specific area of "Surgery and Virtual Tools"- this project integrates computational techniques for simulation of the surgical procedure, including the imaging effects unique to freezing, and predictions of the bioheat transfer process in the clinically treated area. Emphasis is placed on cryosurgery database design, data retrieval, visualization and graphical interfaces, where the database includes imaging data, geometrical modeling of the target region, cryodevice characteristics, and thermal field history. This project utilizes rapid simulation techniques for bioheat transfer, and recently developed algorithms for computerized planning of cryosurgery. The broader impact of this training tool can potentially far exceed its specific application to cryosurgery, by applying similar methodology to other thermal modalities in surgery, such as focused ultrasound, microwave, laser probes, and other multi-source heating elements.