Virtual and Augmented Reality Guidance for Hepatic RFA

描述（由申请人提供）：该项目的主要目标是利用最先进的计算机可视化技术改善肝脏射频消融（RFA）治疗的临床结果。我们假设，使用上下文正确的三维（3D）可视化系统，医生将比单独使用标准二维超声更准确地靶向肝肿瘤的RFA治疗。如果被证明是有益的，该技术可用于降低rfa后肿瘤复发率（目前为33-48%），并改善每年数千例肝脏肿瘤患者的生活。本研究将进行四个主要阶段的研究：验证我们的定量RFA幻像和分割方法；一项大型随机对照试验，比较几种使用RFA幻象的RFA引导方法；土拨鼠肝细胞癌模型的随机对照试验；还有一项小型的随机对照试验，对人类的安全性和有效性进行了测试。此外，我们将开展几项技术和协同研究工作，包括改进临床显示系统的校准，开发此类系统的全自动连续校准方法，以及确定向新手医生教授RFA技术的增强指导系统的有效性。这项研究最直接的潜在好处是减少RFA部位附近的肿瘤复发率，因为消融区边界的定位和估计更准确。这项研究还将为开发更复杂的引导系统奠定基础，使治疗大型和更复杂的病变成为可能。由于该放置任务与许多其他临床消融或活检任务相似，我们期望这些结果的适用性远远超出肝脏RFA。最后，我们可能会发现该系统对于新手用户进行空间复杂程序（如RFA）的训练是有效的。该研究还将提供目前RFA缺乏的两种重要的治疗研究工具：定量准确的模型和体内肝脏肿瘤的大型动物模型。定量幻影将允许小组评估精确RFA放置和消融区域预测和测量的新技术。土拨鼠模型将允许在人体研究之前进行更现实的体内实验。

DESCRIPTION (provided by applicant): The primary goal of this project is to improve the clinical outcomes of hepatic radiofrequency ablation (RFA) therapy using state-of-the-art computer visualization techniques. We hypothesize that physicians will be more accurate in targeting RFA therapy to hepatic tumors using a contextually-correct three-dimensional (3D) visualization system than they could be with standard two-dimensional ultrasound alone. If proven beneficial, this technique could be used to decrease the post-RFA tumor recurrence rate (currently 33-48%) and improve the lives of thousands of patients with hepatic tumors annually. This study will proceed through four major phases of research: validation of our quantitative RFA phantom and segmentation methods; a large, randomized controlled trial comparing several methods of RFA guidance using our RFA phantoms; a randomized, controlled trial using the woodchuck model of hepatocellular carcinoma; and, a small randomized, controlled trial of safety and efficacy in humans. In addition, we will conduct several technical and synergistic research efforts, including improving the calibration of clinical display systems, developing fully automatic, continuous calibration methods for such systems, and determining the efficacy of enhanced guidance systems for teaching RFA techniques to novice physicians. The most immediate potential benefit of this research could be reduced tumor recurrence near RFA sites because of more accurate placement and estimation of the ablation zone boundaries. This research will also serve as the groundwork for the development of more sophisticated guidance systems to enable treatment of large and more complex lesions. Because of the similarity of this placement task to many other clinical ablation or biopsy tasks, we expect that these results would have applicability well beyond hepatic RFA. Finally, we may find that this system is effective for training novice users in the conduct of spatially complex procedures like RFA. This study will also provide two (2) important therapeutic research tools that are currently lacking for RFA: a quantitative accuracy phantom and a large animal model for in vivo hepatic tumors. The quantitative phantom will allow groups to evaluate new techniques for accurate RFA placement and ablation zone prediction and measurement. The woodchuck model will allow for more realistic in vivo experimentation as a step before human studies.