Deformation Corrected Image Guided Laparoscopic Liver Surgery

摘要 肝脏肿瘤是美国和世界范围内的一个主要医疗保健问题。2020年，据估计， 美国新增42,810例原发性肝癌病例，相关死亡人数超过30,160人(在全球范围内，这是20倍 更大)。此外，自1980年以来，美国的原发性肝癌增加了两倍，并以每年3%的速度增长 2006-2015年。这一增长在很大程度上归因于肥胖、糖尿病和脂肪肝(FLD)，这些疾病 迅速取代与病毒和酒精相关的肝病成为肝细胞癌(HCC)的主要因素。 由于有限的手术候选，以及缺乏移植的可获得性，管理的局部区域治疗 疾病的传播和作为移植的桥梁是一个高度活跃的研究领域。一种局部区域疗法 尤其是热消融，在两种经皮手术的局部肝癌控制方面都有很长的历史。 在手术中。在肝脏的热疗中，微波消融(Mwa)正迅速成为一种受欢迎的治疗方法。 治疗。MWA的优点是创造了大的空间范围的能量沉积，可以穿透 烧焦的组织，并具有消融大血管及其周围的能力。然而，常见的是 局部治疗，消融量对于任何给定的患者来说都很难预测，即商业指导 信息很普通，复发和并发症仍然是问题。基本的科学前提 这一应用的基础是，改进微波消融(MWA)治疗本质上依赖于 精确定位和确定与空间编码疾病和 解剖学信息。候选人将追求的总体假设是量化的磁性 磁共振(MR)成像可以用来创建解剖和物质上特定于对象的计算 可以预测准确的微波探头消融热剂量以改善消融的模型 结果。主要目标将是创建多物理建模能力，以适当地计划和 预测患者特定的热消融剂量。为此，我们提出了要完成的三项工作：(1) 开发和实现微波消融建模和计划的软件目标，(2)使用脂肪量化 来自文献的数据，以估计FLD可能对剂量预测的影响，以及(3)开始 可行性研究证明了由术前成像(FAT)驱动的改进的热剂量预测 量化和灌注成像)。如果完全实现，这项工作将深刻地塑造计划、交付、 和微波消融治疗的控制。图像数据驱动的方法将允许程序前 特定于患者的消融计划，在程序内实现增强的定位，以及预测/调整 MWA热剂量范围。

Summary Hepatic tumors represent a major health care problem in the U.S. and worldwide. In 2020, there is an estimated 42,810 new cases of primary liver cancer in U.S. with over 30,160 related deaths (worldwide, this is 20 fold greater). In addition, primary liver cancer has tripled in the U.S. since 1980 and has risen 3% each year from 2006-2015. Much of this rise has been attributed to obesity, diabetes, and fatty liver disease (FLD), which are rapidly replacing viral- and alcohol-related liver disease as a major factor of hepatocellular carcinoma (HCC). Due to limited surgical candidacy, and lack of transplant availability, locoregional therapies for the management of disease and as a bridge-to-transplant are a highly engaged area of investigation. One locoregional therapy in particular, thermal ablation, has a long history in local liver cancer control in both percutaneous procedures and within surgery. Among thermal therapies for liver, microwave ablation (MWA) is rapidly becoming a favored treatment. MWA has the advantage of creating a large spatial extent of power deposition, can penetrate through charred tissues, and has the capacity to ablate up to and around large vessels. However, common to locoregional therapies, ablation volumes can be difficult to predict for any given patient, i.e. commercial guidance information is quite generic, and recurrence and complications are still problems. The basic scientific premise underpinning this application is that improving microwave ablation (MWA) therapy is intrinsically dependent on the precise localization and determination of dose extent in relation to spatially-encoded disease and anatomic information. The overall hypothesis that the candidate will pursue is that quantitative magnetic resonance (MR) imaging can be used to create both anatomically and materially subject-specific computational models such that accurate microwave probe ablation thermal dosing can be forecast to improve ablation outcomes. The primary aim will be to create a multi-physics modeling capability to appropriately plan and forecast a patient-specific thermal ablative dose. In this aim, we propose three tasks to be accomplished: (1) develop and achieve software goals for microwave ablation modeling and planning, (2) using fat quantification data from the literature to estimate the influence that FLD could have on dose prediction, and (3) begin a feasibility study to demonstrate improved thermal dose prediction as driven by pre-procedural imaging (fat quantification, and perfusion imaging). If fully realized, this work could profoundly shape the planning, delivery, and control of microwave ablative therapy. The image-data-driven approach would allow for pre-procedural patient-specific ablation plans, intra-procedurally enable enhanced localization, and the prediction/adjustment of MWA thermal dose extent.