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

描述（由申请人提供）：该项目旨在通过创新且廉价的方法增强InnerOptic的InVision系统（IVS）在肝肿瘤消融术期间的针引导能力，从而“真实的实时”扭曲术前CT数据。“消融已被证明是一种有前途的替代手术切除治疗肝肿瘤，但针放置困难已报告，由于不良的可视化解剖与目前可用的技术。常规的超声引导是术中的，但是一些肿瘤仅在计算机断层扫描（CT）中可见;然而，一旦组织移动甚至少量（例如，呼吸）。我们已经开发了IVS技术来解决这个问题：通过它，消融针和用于针引导的术中超声换能器的位置和方向被持续监测。当医生将针朝向目标推进时，立体计算机生成的实时可视化显示针和换能器的动态化身;以这种方式，针和超声切片之间的空间关系是清楚的，并且外科医生可以更容易地用消融针瞄准超声切片中的特征。在这里，我们提出了一个改进的指导系统，将进一步提高医生的空间理解。我们介绍了一种新颖的和计算成本低廉的手段来扭曲术前计算机断层扫描（CT）数据，并更新了指导系统，该系统将实时变形的CT数据与术中超声配准。然后，医生将受益于由超声和CT数据两者提供的补充信息，并且可以最佳地规划和执行消融手术。在这第一阶段，我们建议透过加强现有的IVS来开发原型，从而利用我们现有的硬件和软件。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程学方面的机会，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手术。在未来，它可以适用于任何使用针头，超声波和术前扫描（如CT或MRI）的手术。公共卫生相关性：我们提出了一种先进的可视化系统，用于肝肿瘤的消融，这是一种外科手术，其中将针状装置插入癌性病变的中心，并以某种方式通电，以便“燃烧”并有效地去除胆怯的组织。作为手术切除的一种有前途的替代方案，这种方法与传统切除相比具有几个优点，包括减少创伤和患者的恢复时间，但它需要超声检查的重要技能，以指导仔细放置探头，以最大限度地破坏肿瘤，并最大限度地减少健康组织的破坏。这里提出的系统将允许即使是新手外科医生准确和快速地放置探针，并且可以使专家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.