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

描述(由申请人提供)：该项目计划通过一种创新且廉价的方法“实时”扭曲术前CT数据，来增强InnerOptic的Invision System(IVS)在肝肿瘤消融术中针头引导的能力。消融术已被证明是一种很有前途的手术切除治疗肝肿瘤的替代方法，但由于目前可用的技术对解剖结构的可视化较差，因此有报道称针头放置困难。传统的超声引导是术中的，但一些肿瘤只能在计算机断层扫描(CT)中看到；然而，软组织的CT数据一旦组织有少量移动(例如，呼吸)就会过时。我们已经开发了IVS技术来解决这个问题：通过它，持续监测消融针和术中用于针导引的超声换能器的位置和方向。当医生将针朝目标推进时，立体计算机生成的实时可视化显示针和换能器的动态头像；以这种方式，针和超声切片之间的空间关系清晰，并且外科医生可以更容易地利用消融针瞄准超声切片中的特征。在这里，我们建议对这一指导系统进行改进，以进一步提高医生的空间理解能力。我们介绍了一种新的、计算上廉价的方法来扭曲术前计算机断层扫描(CT)数据，以及一种更新的引导系统，该系统将实时变形的CT数据与术中超声配准。医生将从超声和CT数据提供的补充信息中受益，并可以最佳地计划和执行消融程序。在此第一阶段，我们建议通过增强我们现有的IVS来开发原型，从而利用我们已经可用的硬件和软件。然后，我们将验证系统的性能准确性，并由我们的外科医生顾问进行定量和定性测试。我们将进行两轮测试：第一轮将提供优化设备人体工学方面的机会，第二轮将产生定量和定性的性能数据。这里描述的技术绝不限于消融程序。在未来，它可以适应任何使用针头、超声波和手术前扫描(如CT或MRI)的程序。公共卫生相关性：我们提出了一种先进的肝脏肿瘤消融可视化系统，这是一种外科手术程序，将针状装置插入癌症病变的中心，并以某种方式提供能量，以“烧伤”的方式有效地移除胆汁组织。作为手术切除的一种有希望的替代方法，这种方法与传统的切除方法相比有几个优点，包括减少创伤和患者的恢复时间，但它需要丰富的超声技能来指导仔细放置探头，这是最大限度地破坏肿瘤和最小化健康组织所必需的。这里提出的系统将允许即使是新手外科医生准确而快速地放置探头，并使专业外科医生能够更快地执行手术。

DESCRIPTION (provided by applicant): This project proposes to enhance the capabilities of InnerOptic's InVision System (IVS) for needle guidance during hepatic tumor ablation procedures via an innovative and inexpensive method to warp pre-operative CT data in "real time." Ablation has been demonstrated as a promising alternative to surgical resection to treat hepatic tumors, but needle placement difficulties have been reported due to poor visualization of the anatomy with currently-available technology. Conventional ultrasound guidance is intra-operative, but some tumors are only visible in computed tomography (CT); however, CT data of soft tissue becomes obsolete as soon as the tissue moves even a small amount (e.g., from breathing). We have already developed the IVS technology to address this problem: with it, the positions and orientations of the ablation needle and of the intra-operative ultrasound transducer used for needle guidance are continually monitored. A stereoscopic computer-generated real-time visualization displays dynamic avatars of needle and transducer as the physician advances the needle towards the target; in this way, the spatial relationship between needle and ultrasound slice is clear, and the surgeon can more easily target a feature in the ultrasound slice with the ablation needle. Here, we propose an improvement to this guidance system that will enhance a physician's spatial understanding even further. We introduce a novel and computationally-inexpensive means to warp pre-operative computed tomography (CT) data, and an updated guidance system that incorporates the real-time-deformed CT data in registration with the intra-operative ultrasound. The physician would then benefit from the complementary information provided by both the ultrasound and CT data, and could optimally plan and execute the ablation procedure. In this Phase I, we propose to develop the prototype by enhancing our existing IVS, and thus leveraging hardware and software that is already available to us. We will then verify the performance accuracy of the system, and proceed with both quantitative and qualitative testing by our surgeon consultants. We will pursue two rounds of testing: the first will provide an opportunity to optimize the ergonomic aspects of the device, and the second will yield both quantitative and qualitative performance data. The technology described here is by no means limited to ablation procedures. In the future, it could in the future be adapted to any procedure in which needles, ultrasound and pre-operative scans such as CT or MRI are employed. PUBLIC HEALTH RELEVANCE: We propose an advanced visualization system for ablation of hepatic tumors, which is a surgical procedure in which a needle-like device is inserted into the center of a cancerous lesion and is energized in a way so as to "burn" and effectively remove the timorous tissue. A promising alternative to surgical resection, this approach has several advantages over traditional resection, including reduced trauma and recovery time for the patient, but it requires significant skill with ultrasonography for guidance in the careful placement of the probe that is required for maximization of tumor destruction, and minimization of healthy tissue destruction. The system proposed here will allow even a novice surgeon to place the probe accurately and quickly, and can enable an expert surgeon to perform the procedure more quickly.