Computer-Aided Decision Support System for Catheter-Based Pulmonary Valve Replacement

基于导管的肺动脉瓣置换术的计算机辅助决策支持系统

• 批准号: 9908686
• 负责人: Venkata Sreekanth Arikatla
• 金额: $ 22.3万
• 依托单位: KITWARE, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-20 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9908686
• 关键词: 3-Dimensional; 3D Print; Address; Adult; Cardiac Surgery procedures; Cardiology; Catheters; Clinical; Computer Assisted; Computer Models; Computers; Decision Aid; Decision Making; Decision Support Systems; Defect; Device Designs; Devices; Dimensions; Distal; Elements; Eligibility Determination; Engineering; Face; Failure; Feasibility Studies; Friction; Future; Generations; Graph; Heart failure; Human; Image; Implant; Infant; Interdisciplinary Study; Intervention; Intuition; Investigation; Life; Measures; Mechanics; Medical Imaging; Methodology; Methods; Modeling; Morphology; Newborn Infant; Operative Surgical Procedures; Palliative Surgery; Patients; Pediatric Hospitals; Performance; Phase; Philadelphia; Population; Population Heterogeneity; Process; Pulmonary Valve Insufficiency; Pulmonary artery structure; Pulmonary valve structure; Residual Tumors; Right ventricular structure; Scientist; Shapes; Sheep; Small Business Innovation Research Grant; Stents; Stress; System; Techniques; Time; United States; Validation; Ventricular; Visualization; X-Ray Computed Tomography; base; clinical decision-making; computational platform; congenital heart disorder; cost; design; device physics; experience; flexibility; imaging platform; implantable device; implantation; improved; individual patient; mechanical behavior; novel; open source; patient subsets; pediatric cardiologist; preclinical study; prototype; pulmonary valve replacement; reconstruction; screening; seal; simulation; tool; valve replacement; verification and validation

ABSTRACT The aim of this proposal is to design, develop, and validate an interactive easy-to-use computer modeling tool that will help choose the best Transcatheter Pulmonary Valve Replacement (TPVR) device for an individual patient. Increased availability of a variety of self-expanding TPVR devices with varying shapes and sizes increases the number of candidates for TPVR but will require tools that can improve the efficiency and accuracy of determining patient eligibility as well as the optimal, patient-specific device. Current screening techniques are labor intensive, expensive, and continue to rely primarily on basic 2D morphological measures from CT reconstructions of the right ventricular outflow tract (RVOT) and implantation of actual devices into 3D printed models to visually assess device fit. Therefore, a clinical-grade application warrants integration of realistic physics of device mechanics, deformable vessel walls and their interaction at higher accuracy, as well as generation of quantitative metrics and visualizations within an intuitive user interface. The proposed tool will model the vessel wall, self-centering of the self-expanding device and their interactions using finite elements which will be incorporated as an external module for 3D Slicer-an open- source medical imaging platform. Metrics such as device dimensions, compression, maximum stress from contact, and assessment of proximal and distal circumferential seal will be automatically computed, visualized and graphed for the cardiologists, facilitating determination of patient candidacy and the optimal choice of a device for an individual patient. Our tool improves upon the current methods by incorporating (i) high-fidelity contact modeling including a frictional contact model between the device and the vessel wall, (ii) automatic estimation of the crucial metrics, (iii) near real-time performance allowing for incorporation into clinical workflows, and (iv) methodology verification and clinical validation. Modeling accuracy will be verified by comparing models based on existing pre-implant CT scans to post device implant CT scans in an ovine model of pulmonary insufficiency. Further, the 3D Slicer extension tool will be evaluated by three experienced interventional cardiologists (> 5 years of experience) at CHOP, who routinely perform TPVR implant for its (1) ease of navigation; (2) quantitative metrics; (3) visualizations, and (4) overall utility for clinical decision making.

摘要 本提案的目的是设计、开发和验证一个交互式的易于使用的计算机建模 该工具将帮助选择最佳的经导管肺动脉瓣置换术（TPVR）器械， 个别患者。增加了各种形状各异的自膨胀式TPVR装置的可用性， 尺寸增加了TPVR的候选数量，但需要能够提高效率的工具， 确定患者合格性的准确性以及最佳的患者专用器械。目前的筛选 技术是劳动密集型的，昂贵的，并且仍然主要依赖于基本的2D形态测量 从右心室流出道（RVOT）的CT重建和将实际器械植入3D 打印模型以目视评估器械适配性。因此，临床级应用程序需要集成 器械力学、可变形血管壁及其相互作用的真实物理学，以及更高精度 如在直观的用户界面内生成定量度量和可视化。 所提出的工具将对血管壁、自扩张装置的自定心以及它们的特性进行建模。 使用有限元的相互作用，将作为3D Slicer的外部模块，这是一个开放的， 源医学影像平台。器械尺寸、压缩、最大应力等参数 将自动计算、可视化近端和远端周向密封的接触和评估 为心脏病专家绘制图表，便于确定患者候选资格和最佳选择 为个别患者提供的设备。我们的工具通过结合（i）高保真度来改进当前的方法 接触建模，包括所述装置与所述血管壁之间的摩擦接触模型，（ii）自动 关键指标的估计，（iii）允许纳入临床的近实时性能 工作流程，以及（iv）方法学验证和临床验证。 将通过比较基于现有植入前CT扫描的模型与植入后CT扫描的模型来验证建模准确性。 在肺功能不全的绵羊模型中进行器械植入物CT扫描。此外，3D Slicer扩展工具将 由CHOP的三名经验丰富的介入心脏病专家（> 5年经验）进行评价， 常规进行TPVR植入，因为其（1）易于导航;（2）定量指标;（3）可视化，和（4） 临床决策的整体效用。