Computer Modeling of Surgical Outcomes for Nasal Airway Obstruction

鼻气道阻塞手术结果的计算机建模

• 批准号: 7892016
• 负责人: JOHN S RHEE
• 金额: $ 18.69万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7892016
• 关键词: Affect; Air; Air Conditioning; Airway Resistance; Allergic; Anatomy; Area; Arts; Biomedical Engineering; Computer Analysis; Computer Simulation; Computer software; Computer-Aided Design; Computerized Medical Record; Consult; Counseling; Data; Deformity; Diagnosis; Disease; Enrollment; Evaluation; Failure; Future; Goals; Healed; Health; Heating; Humidity; Individual; Intervention; Liquid substance; Measures; Medicine; Methods; Modeling; Modification; Moods; Nasal cavity; Nasal obstruction present finding; Nose; Operative Surgical Procedures; Outcome; Paramedical Personnel; Patient Outcomes Assessments; Patients; Pattern; Pharmaceutical Preparations; Physicians; Physiology; Population; Procedures; Process; Quality of life; Questionnaires; Recreation; Reporting; Resistance; Scanning; Sleep; Statistical Models; Surgeon; Surgical Models; Symptoms; Techniques; Technology; Telemedicine; Testing; Time; Training; Translations; Visual; X-Ray Computed Tomography; age group; airway obstruction; analog; base; cohort; computerized tools; demographics; design; digital; functional outcomes; healing; improved; medical specialties; novel; predictive modeling; public health relevance; reconstruction; shear stress; tool; user-friendly; virtual; water vapor

DESCRIPTION (provided by applicant): Nasal airway obstruction (NAO) is a common health condition that is treated by many specialties of medicine and often needs surgical correction. The complexity of the nasal airway lends itself perfectly to the creation of a computational tool to aid clinicians in the diagnosis and treatment of NAO. In the context of surgical failure rates for treatment of NAO reported as high as 50%, none of the existing objective measures of nasal airflow patency has been shown to consistently correlate with patient symptomatology or to be an accurate predictor of successful surgical intervention. The long-term goal of this study is to develop a tool that would be universally accessible to clinicians and be accurately predictive of patient's symptoms. Even more exciting would be a tool that would aid surgeons in designing specific surgical techniques or interventions that would maximize the potential for successful outcomes. With the availability of powerful bioengineering computer-aided design software, anatomically- accurate, three dimensional computational models can be generated from patient-specific digital data captured by computed tomography (CT) scans. Computational fluid dynamics (CFD) techniques allow for the merger of anatomy with physiology by creating a virtual model of the nasal cavity with computed measures of airflow, heat transfer, and air humidification. The potential for improvements in patient outcome when CFD modeling tools are used in nasal surgical planning is enormous, particularly for previously challenging cases. In addition, unnecessary surgical procedures may potentially be reduced by allowing the physician to better select surgically treatable patients and to target specific areas of concern within the nasal valve region without "guessing" which of the procedures may be most beneficial to the patient. Furthermore, the computed nasal geometry can be virtually modified in a manner reflecting surgical techniques and new patterns of airflow and heat and water vapor transport can be predicted that could effectively estimate surgical outcomes - i.e virtual surgery. This study proposes to evaluate the association between this novel bioengineering tool (CFD) with patient-reported subjective measures of nasal obstruction. Furthermore, because CFD modeling allows the nasal geometry to be virtually modified in a manner reflecting surgical techniques, the findings of this study would lay the groundwork for future pre-surgical virtual surgery and predictive modeling for post-surgical outcomes with the ultimate long-term goal of improved surgical outcomes for patients with nasal airway obstruction. PUBLIC HEALTH RELEVANCE: Nasal airway obstruction (NAO) is a common health condition that crosses many specialties of medicine and affects all age groups. NAO has been shown to impact mood, energy, recreation, sleep and overall quality of life. It is estimated that annually $5 billion is spent on medications to treat NAO and an additional $60 million is spent on surgical therapy. An anatomic basis for NAO is common; it has been reported that up to 25% of the population suffers from nasal obstruction due to anatomic deformities unrelated to allergic reasons. However, the surgical correction of nasal anatomic deformities has not always been successful in improving patient's symptoms of NAO, with reported surgical failure rates as high as 50%. Computational fluid dynamics (CFD) techniques is a novel state-of-the art technology that allows for the merger of nasal anatomy with physiology. The potential for improvements in patient outcome when CFD modeling tools are used in nasal surgical planning is enormous, particularly for previously challenging cases. In addition, unnecessary surgical procedures may potentially be reduced by allowing the physician to better select surgically treatable patients and to target specific areas of concern within the nasal valve region without "guessing" which of the procedures may be most beneficial to the patient. In addition, the futuristic scenario of a physician using electronic medical records to download CT data into a user-friendly, simplified CFD software package to rapidly create a CFD model for each patient is not too hard to conceive. The physician can then make changes to the model with immediate computations of changes of nasal airway resistance, airflow distributions, and heat and humidity alterations. The patient would then be counseled on the appropriate surgical plan and the physician can use the virtual surgery model to help plan his/her surgical approach. Extending beyond the individual patient level, this modeling tool can serve as a powerful educational tool for physicians- in-training and paramedical personnel. Furthermore, with the universality of CT scans and the ability to post-process the "raw data", the potential for telemedicine consulting for difficult nasal airway cases would also become more appealing and fruitful.

描述（由申请人提供）：鼻气道阻塞（NAO）是一种常见的健康状况，可通过许多专业医学治疗，通常需要手术矫正。鼻气道的复杂性使其完全适合于创建一种计算工具，以帮助临床医生诊断和治疗NAO。在NAO治疗的手术失败率高达50%的情况下，现有的鼻气流通畅性客观指标均未显示与患者的鼻内窥镜学一致相关或准确预测手术干预成功。这项研究的长期目标是开发一种临床医生普遍使用的工具，并准确预测患者的症状。更令人兴奋的将是一种工具，它将帮助外科医生设计特定的手术技术或干预措施，以最大限度地提高成功结果的潜力。随着强大的生物工程计算机辅助设计软件的可用性，可以从通过计算机断层摄影（CT）扫描捕获的患者特异性数字数据生成解剖学上精确的三维计算模型。计算流体动力学（CFD）技术允许通过创建具有计算的气流、热传递和空气加湿的测量的鼻腔的虚拟模型来合并解剖学与生理学。当CFD建模工具用于鼻外科手术计划时，患者预后改善的潜力是巨大的，特别是对于以前具有挑战性的病例。此外，通过允许医生更好地选择可手术治疗的患者并靶向鼻阀区域内的特定关注区域而无需“猜测”哪个手术可能对患者最有益，可以潜在地减少不必要的手术。此外，可以以反映手术技术的方式虚拟地修改计算的鼻部几何形状，并且可以预测可以有效地估计手术结果的气流和热和水蒸气输送的新模式，即虚拟手术。本研究旨在评估这种新型生物工程工具（CFD）与患者报告的鼻塞主观测量之间的相关性。此外，由于CFD建模允许以反映手术技术的方式虚拟修改鼻部几何形状，因此本研究的结果将为未来的术前虚拟手术和术后结果的预测建模奠定基础，最终长期目标是改善鼻气道阻塞患者的手术结果。公共卫生关系：鼻气道阻塞（NAO）是一种常见的健康状况，涉及许多医学专业，影响所有年龄组。NAO已被证明会影响情绪，精力，娱乐，睡眠和整体生活质量。据估计，每年花费50亿美元用于治疗NAO的药物，另外花费6000万美元用于手术治疗。NAO的解剖学基础很常见;据报道，高达25%的人群因与过敏原因无关的解剖学畸形而患有鼻塞。然而，鼻解剖畸形的手术矫正并不总是成功地改善患者的NAO症状，据报道手术失败率高达50%。计算流体动力学（CFD）技术是一种新型的最先进技术，可以将鼻腔解剖学与生理学结合起来。当CFD建模工具用于鼻外科手术计划时，患者预后改善的潜力是巨大的，特别是对于以前具有挑战性的病例。此外，通过允许医生更好地选择可手术治疗的患者并靶向鼻阀区域内的特定关注区域而无需“猜测”哪个手术可能对患者最有益，可以潜在地减少不必要的手术。此外，医生使用电子病历将CT数据下载到用户友好的简化CFD软件包中，为每个患者快速创建CFD模型的未来场景也不难想象。然后，医生可以通过立即计算鼻气道阻力、气流分布以及热量和湿度变化来改变模型。然后，患者将被告知适当的手术计划，医生可以使用虚拟手术模型来帮助计划他/她的手术方法。扩展到个体患者水平之外，该建模工具可以作为医生培训和辅助医疗人员的强大教育工具。此外，随着CT扫描的普及和对“原始数据”进行后处理的能力，针对困难鼻气道病例的远程医疗咨询的潜力也将变得更具吸引力和富有成效。