Advanced Visuohaptic Surgical Planning for Trauma Surgery

描述(由申请人提供)： 前言：面颈部复杂创伤患者的治疗是外科领域最具挑战性的多学科任务之一。最近对从伊拉克战争中返回的受伤士兵的研究表明，战斗受伤的模式发生了重大变化。在凯夫拉防弹衣出现之前，大多数战斗死伤都源于胸部或头骨的伤口。今天，21%的战伤士兵头盔线以下的头部和颈部受到创伤。在过去的20年里，钢板系统的引入和外科技术的变化使纠正头部和颈部的严重畸形成为可能。术前计划是这些复杂手术成功的关键。成像技术已经从2-D发展到3-D，从静态图形绘制发展到动画图形绘制，这极大地方便了复杂创伤的诊断。基于患者个体三维数据的仿真技术将对手术计划和培训产生关键影响。模拟可变形组织的现场和远程访问虚拟环境将允许外科医生计划和模拟手术，并保留他们的技能，以应对不常见的手术。具体目标：本提案的研究目标是开发和评估重建手术计划的计算环境。建议的工具将允许交互式可视化和触觉操作的图像，从计算机断层扫描(CT)扫描的个别患者的头部和颈部受伤。我们预计，与依赖物理模型的传统技术相比，计算工具将更精确、更快、更灵活。该计算工具还可以远程访问，允许外科医生模拟和规划具有专家反馈的手术病例。该研究计划包括以下要素：1)开发用于交互地探索CT数据、指定手术切割、操纵骨碎片和定位重建板的可视触觉虚拟环境2)开发用于获取和记录用于外科规划的3D模型的物理测量的界面3)增强该环境以包括半自动特征以进一步减少规划时间并潜在地提高精度超过通过传统技术可获得的精度4)执行验证研究以开发具有外科规划意义的远程医疗应用：所提议的外科规划环境的意义源于其允许外科医生模拟、规划、并根据CT扫描的3-D患者数据迭代复杂的程序。该软件将允许外科医生在实际手术之前看到和感受他们干预的结果-例如，严重头部创伤后重建的颌骨的咬合质量或骨对齐-从而为患者带来更好的规划、更少的错误、缩短手术时间和改善结果。该系统将可以远程访问，这样外科医生就可以独立于他们的位置使用它。对退伍军人医疗保健的潜在影响：虚拟手术规划系统可以为患有头颈部创伤和癌症需要重建手术的退伍军人管理局患者提供许多好处。退伍军人管理局处于远程医疗应用的理想位置，例如虚拟手术规划系统，因为强大的通信基础设施和连接所有退伍军人管理局医疗设施的电子网络允许安全地交换数据。因此，治疗团队可以使用虚拟手术计划系统来为患者提供最好的护理，而与患者或提供者的位置无关。

DESCRIPTION (provided by applicant): Introduction: The treatment of patients with complex facial and neck trauma is one of the most challenging multidisciplinary tasks in surgery. Recent studies on injured soldiers returning from the Iraq war have shown that the pattern of combat injuries has changed significantly. Before the advent of Kevlar body armor, most combat deaths and injuries stemmed from wounds to the chest or skull. Today 21% of soldiers with battle injuries suffer from trauma to the head and neck below the helmet line. The introduction of plating systems and changes in surgical techniques over the last 20 years have made correction of severe malformations in the head and neck possible. Preoperative planning is essential for a successful outcome of these complex procedures. Imaging has evolved from 2-D to 3-D, and from static to animated graphic rendering, and this has greatly facilitated diagnosis of complex traumatic injuries. Simulation technology based on 3D data of an individual patient will have a critical impact on surgical planning and training. Onsite and remotely accessible virtual environments simulating deformable tissues will allow surgeons to plan and simulate operations and retain their skills for infrequent operations. Specific Aims: The research goal of this proposal is the development and evaluation of a computational environment for the planning of reconstructive surgery. The proposed tool will allow interactive visualization and haptic manipulation of images derived from computed tomography (CT) scans of an individual patient with a head and neck injury. We anticipate that a computational tool will be more precise, faster, and more flexible than conventional techniques that depend on physical models. The computational tool can also be accessed remotely and allowing a surgeon to simulate and plan a surgical case with expert feedback. The research plan consists of the following elements: 1) Develop a visuohaptic virtual environment for interactively exploring CT data, specifying surgical cuts, manipulating bone fragments, and positioning of reconstruction plates 2) Develop an interface for taking and recording physical measurements from 3-D models for surgical planning 3) Enhance the environment to include semi-automation features to further reduce planning time and potentially increase accuracy beyond what is available via conventional techniques 4) Perform a validation study to develop a Telemedicine application for surgery planning Significance: The significance of the proposed surgical planning environment stems from its ability to allow surgeons to simulate, plan, and iterate on complex procedures based on individual patient data in 3-D from a CT scan. The software will allow surgeons to both see and feel the results of their interventions - for example, the quality of the bite or bone alignment of a reconstructed jaw following severe head trauma - before the actual surgery, leading to better planning, fewer errors, shortened surgery time and improved outcomes for the patient. The system will be accessible remotely so that surgeons can use it independent of their location. Potential Impact on Veterans Health Care: A virtual surgical planning system can provide many benefits to VA patient with head and neck trauma and cancer requiring reconstructive surgery. The VA is in an ideal position for telemedicine applications such as a virtual surgery planning system due to a strong communications infrastructure and electronic network that connects all VA medical facilities allowing secure exchange of data. The treatment team can thus use the virtual surgical planning system to provide the best care for the patient, independent of patient or provider location.