An Integrated System for Image-Guided Radiofrequency Ablation of Liver Tumors

描述（由申请人提供）：本提案的总体目标是开发和确认基于开源软件的集成系统，以改善肝脏肿瘤射频消融（RFA）期间的可视化和探头放置。虽然射频消融正在成为不可切除的肝细胞癌（HCC）和肝转移瘤的一种越来越重要的治疗选择，但该手术存在一些技术限制。这些局限性主要与精确放置RFA针以消融整个肿瘤并获得足够边缘的困难有关。特别是，较大的肿瘤需要多个重叠的针头放置，这可能很难实现。该项目的具体目标是：1）为肝脏RFA规划/治疗工作站开发一个开源软件架构，该架构建立在两个合作机构现有的开源项目基础上2）开发和评估肝脏、肝脏血管和肝脏肿瘤的半自动分割技术。这些技术将与图形用户界面集成，分割结果将通过与放射科专家进行比较进行评价。3)基于分割的肝脏数据集，开发一个路径规划模块，用于评估肝脏肿瘤的替代路径，并根据需要合并多个重叠放置。4)将以上开发的两种功能沿着RFA探头的电磁跟踪相结合，为肝脏肿瘤规划、可视化和执行提供完整的软件环境。该软件环境将合并乔治敦和布里格姆妇女医院正在进行的工作，开发用于图像引导程序的开源软件。5)验证了该系统在猪动物模型中的临床可行性。将在猪肝中创建琼脂结节，并评估系统分割这些结节并提供路径规划的能力。还将评估系统的准确性。这项研究对于推进肝癌治疗技术具有重要意义，目前可用的治疗方法无法很好地治疗肝癌。这项技术还将实现现代化的个性化治疗，这依赖于高功率计算机和医学创新的整合。它将通过开发肝癌治疗而不需要更多的侵入性手术来为公共卫生做出贡献。

DESCRIPTION (provided by applicant): The overall goal of this proposal is to develop and validate an integrated system based on open source software for improved visualization and probe placement during radiofrequency ablation (RFA) of liver tumors. While radiofrequency ablation is becoming an increasingly important treatment option for unresectable hepatocellular carcinoma (HCC) and liver metastases, the procedure has several technical limitations. These limitations are mostly related to the difficulty of precisely placing the RFA needle to ablate the entire tumor and achieve adequate margins. In particular, larger tumors require multiple overlapping needle placements, which can be difficult to achieve. The specific aims of the project are to: 1) Develop an open source software architecture for a liver RFA planning/treatment workstation that builds on existing open source projects at the two collaborating institutions 2) Develop and evaluate semi-automatic segmentation techniques for the liver, liver vasculature, and liver tumors. These techniques will be integrated with a graphical user interface and the segmentation results will be evaluated by comparison with expert radiologists. 3) Based on the segmented liver data set, develop a path planning module for evaluating alternative paths to the liver tumor and incorporating multiple overlapping placements as needed. 4) Integrate the two capabilities developed above along with electromagnetic tracking of the RFA probe to provide a complete software environment for liver tumor planning, visualization, and execution. This software environment will merge ongoing work at Georgetown and Brigham and Women's Hospital in developing open source software for image-guided procedures. 5) Validate the clinical feasibility of the system in a swine animal model. Agar nodules will be created in the swine liver and the ability of the system to segment and provide path planning for these nodules will be assessed. The accuracy of the system will also be evaluated. This research is important in advancing the technology for treatment of liver cancer that presently can not be treated well with current available therapies. This technology would also enable a modern, individualized therapy, which relies on integration of high power computers and innovations in medical science. It would have a contribution to public health by developing liver cancer treatments without the need for more invasive surgeries.