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

摘要 该提案的目的是设计、开发和验证交互式易于使用的计算机建模 工具将有助于为患者选择最佳的经导管肺动脉瓣置换 (TPVR) 设备 个别患者。增加了各种形状各异的自膨胀 TPVR 设备的可用性 尺寸增加了 TPVR 候选者的数量，但需要能够提高效率和 确定患者资格的准确性以及针对患者的最佳设备。当前筛选 这些技术是劳动密集型的、昂贵的，并且仍然主要依赖于基本的二维形态学测量 右心室流出道 (RVOT) 的 CT 重建和实际设备植入 3D 打印模型以目视评估设备适配性。因此，临床级应用程序需要集成 装置力学、可变形血管壁及其高精度相互作用的真实物理 在直观的用户界面中生成定量指标和可视化。 所提出的工具将对血管壁、自膨胀装置的自定心及其它们进行建模 使用有限元进行交互，该有限元将作为 3D Slicer（开放式）的外部模块并入 源医学影像平台。设备尺寸、压缩、最大应力等指标 接触以及近端和远端圆周密封的评估将自动计算、可视化 并为心脏病专家绘制图表，有助于确定患者候选资格和最佳选择 针对个别患者的设备。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，包括设备和血管壁之间的摩擦接触模型，(ii) 自动 关键指标的估计，（iii）接近实时的性能，允许纳入临床 工作流程，以及 (iv) 方法验证和临床验证。 将通过比较基于现有植入前 CT 扫描和植入后的模型来验证建模准确性 肺功能不全绵羊模型中的设备植入 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）进行评估，他们 常规进行 TPVR 植入，因为 (1) 易于导航； (2) 定量指标； (3) 可视化，以及 (4) 临床决策的整体效用。

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.