An Intraoperative Guidance Platform for Radio Frequency Ablation

项目总结： 这项拟议的研究计划的目标是开发一个平台，用于在 射频消融(RFA)。RFA是一种热介质消融技术，其中敷贴器携带 一个电极经皮插入肿瘤内(或通过腹腔镜术，或通过开放的外科手术)。收音机 施加频率(RF)能量，变性和凝固体积为2厘米到5厘米的组织 直径。一些RFA电极的形状像直针；另一些电极则展开一把伞状的尖刺来消融 体积更大。RFA很有吸引力，因为它可以经皮使用，导致微创。RFA是一种广泛的 接受癌症治疗，适用于不同器官的原发和继发肿瘤， 包括肝、肺、肾、乳房和肌肉骨骼介入治疗。射频消融往往是首选的治疗方法。 不能手术的病人的选择。 RFA的典型方法是经皮穿刺法。因此，医生无法直接观察到 电极和组织。术中使用CT和超声波来追踪电极的位置，但 CT和超声(US)在RFA下显示组织坏死性病变的能力有限。这很难 因此，评估哪些组织已经治疗，哪些没有。目前医生依靠的是“心理导图” 他们之前已经消融了哪些组织，并估计下一步要去哪里。坏死量也是 从电极制造商提供的印刷版病变几何图形中“心理上估计”。这些图表 显示均匀组织的预期消融几何形状，但不考虑解剖结构或存在 它可以改变和减少消融体积，因为它们将热量输送出去。 该计划的总体目标是为术前计划和术中计划开发一个平台 RFA指导，基于模拟RFA的电/热效应和实时术中 坏死化模式的预测。将RFA模拟图像融合到CT术中图像上将 建立一个引导系统，能够显示哪些组织已经治疗，哪些组织没有治疗，允许 医生需要正确地重新定位电极并实现一致的重叠。这将改善 RFA尤其适用于肿瘤大于2厘米的患者，其全部坏死率已被证明是 在没有指导的情况下尤其难以实现。

Project Summary: The objective of this proposed research program is to develop a platform for planning and guidance during Radio Frequency Ablation (RFA). RFA is a thermally mediated ablation technique, where an applicator carrying one electrode is inserted into tumors percutaneously (or via laparoscopy, or open surgical approaches). Radio Frequency (RF) energy is applied, denaturating and coagulating tissues in a volume of 2cm to 5cm of diameter. Some RFA electrodes are shaped as straight needles; others deploy an umbrella of tines to ablate a larger volume. RFA is attractive as it can be used percutaneously resulting minimally invasive. RFA is a widely accepted cancer treatment therapy, and is applied to primary and secondary tumors in different organs, including liver, lung, kidney, breast, and in musculoskeletal interventions. RFA is often the preferred treatment option for inoperable patients. The typical approach for RFA is percutaneous. Physicians therefore have no direct view of the location of electrodes and of tissues. CT and Ultrasound are used intraoperatively to track the location of electrodes, but both CT and Ultrasound (US) have limited ability to visualize the necrotization of tissues under RFA. It is hard therefore to assess which tissues have been treated and which not. Currently physicians rely on “mental maps” of where they have previously ablated tissues and estimate where to go next. The necrotization volume is also “mentally estimated” from lesion geometry charts provided in print by electrode manufacturers. These charts show the expected ablation geometry for a uniform tissue and do not account for the anatomy or the presence of blood vessels, which can modify and reduce the ablation volume as they transport heat away. The overarching goal of this program is to develop a platform for pre-operative planning and intraoperative RFA guidance, based on simulation of the electrical / thermal effects of RFA and real-time intraoperative prediction of necrotization patterns. Image fusion of RFA simulations onto CT intraoperative images would constitute a guidance system able to show which tissues have been treated and which not, allowing the physicians to properly repositions electrodes and achieve consistent overlap. This would improve outcomes of RFA particularly for patients with tumors greater than 2cm, for which total necrotization has been shown to be particularly hard to achieve without guidance.