Interactive intraoperative imaging with cone beam CT

描述（由申请人提供）： 尽管影像引导手术（IGS）正在彻底改变耳鼻喉科和神经外科，但其实用性受到两个因素的限制。首先，将术前扫描（CT或MRI）与患者和手术室的坐标系共配准的强制性步骤是麻烦的、耗时的，并且引入不准确性。其次，随着手术的进行，手术期间的组织变化使得术前扫描越来越不准确。与图像引导手术系统完全集成以提供定期更新扫描的交互式术中成像工具将解决这两个问题，并因此增加执行手术的准确性和容易性。然而，迄今为止提出的解决方案-术中超声、MRI、移动的（但本质上是传统的）CT和具有3D功能的C形臂-都失败了，因为它们难以使用、昂贵、产生差的图像或与现有手术室不兼容。我们建议开发一种紧凑的术中锥束CT成像工具，该工具将具有高度交互性，并允许外科医生进行定期更新扫描。拟议工作的长期目标是：1）开发适用于手术室环境的相对低成本和紧凑的硬件平台; 2）开发新技术，以减少的辐射剂量，使用减少的视野采集提供多次术中图像采集; 3）进行初始性能测试，证明与传统IGS系统相比，准确度有所提高。对于第一阶段的工作，我们建议专注于使用缩小的视野，术中扫描更新感兴趣的区域的具体目标。这样的方案将大大减少辐射剂量，并将允许多次术中扫描。术中扫描本身将有助于患者和IGS系统的准确配准，而额外的扫描可用于监测外科手术的进展并提供术后手术评估。

DESCRIPTION (provided by applicant): Although image guided surgery (IGS) is revolutionizing ENT- and neurosurgery, its utility is limited by two factors. First, the mandatory step of co-registering the preoperative scan (either CT or MRI) with the coordinate system of the patient and operating room is cumbersome, time consuming, and introduces inaccuracies. Second, tissue changes during surgery render the preoperative scans less and less accurate as the surgery progresses. An interactive intraoperative imaging tool that is fully integrated with the imageguided surgery system to provide periodic update scans would solve both problems and would thus increase the accuracy and ease of performing surgery. However, solutions proposed so far - intraoperative ultrasound, MRI, mobile (but in essence conventional) CT, and C-arms with 3D capabilities - have failed because they either are difficult to use, are expensive, produce poor images, or are incompatible with existing operating rooms. We propose to develop a compact intraoperative cone-beam CT imaging tool that will be highly interactive and will allow the surgeon to perform periodic update scans. The long-term aims of the proposed work are to 1) develop a relatively low-cost and compact hardware platform appropriate for an OR setting 2) develop novel techniques to provide multiple intraoperative image acquisitions at reduced radiation dose using reduced field of view acquisitions and 3) conduct initial performance testing demonstrating the improved accuracy over traditional IGS systems. For this Phase I effort we propose to focus on the specific aim of using reduced field-of-view, intraoperative scans to update a region of interest. Such a protocol will greatly reduce radiation dose and will allow for multiple intraoperative scans. Intraoperative scans themselves will facilitate accurate registration of the patient and the IGS system, whereas additional scans can be used to monitor the progression of a surgical procedure and to provide postoperative surgical assessment.