An Intraoperative Guidance Platform for Radio Frequency Ablation

描述（由申请人提供）：本拟议研究项目的目标是开发一个射频消融（RFA）期间的计划和指导平台。RFA是一种热介导消融技术，其中将携带一个电极的施用器经皮插入肿瘤（或通过腹腔镜或开放手术方法）。施加射频（RF）能量，使直径为2 cm至5 cm的组织变性和变性。一些RFA电极的形状为直针;另一些则部署了一把尖齿伞，以消融更大的体积。RFA具有吸引力，因为它可以永久使用，从而实现微创。RFA是一种被广泛接受的癌症治疗方法，适用于不同器官的原发性和继发性肿瘤，包括肝、肺、肾、乳腺和肌肉骨骼干预。RFA通常是不可手术患者的首选治疗选择。RFA的典型方法是经皮。因此，医生无法直接看到电极和组织的位置。术中使用CT和超声跟踪电极位置，但CT和超声（US）的可视化能力有限 RFA下组织坏死。因此，很难评估哪些组织已经治疗，哪些没有。目前，医生依靠“心理地图”来判断他们以前消融过的组织，并估计下一步要去哪里。坏死体积也是根据电极制造商提供的印刷品中的病变几何形状图表“心理估计”的。这些图表显示了均匀组织的预期消融几何形状，但未考虑解剖结构或血管的存在，因为血管将热量输送出去，可能会改变和减少消融体积。该项目的总体目标是基于RFA的电/热效应模拟和坏死模式的实时术中预测，开发一个术前计划和术中RFA指导平台。RFA模拟到CT术中图像的图像融合将构成一个引导系统，能够显示哪些组织已经治疗，哪些没有治疗，允许医生正确重新定位电极并实现一致的重叠。这将改善RFA的结局，特别是对于肿瘤大于4cm的患者，在没有指导的情况下，完全坏死特别困难。

DESCRIPTION (provided by applicant): The objective of this proposed research program is to develop a platform for planning and guidance during Radio Frequency Ablation (RFA). RFA is a thermally mediated ablation technique, where an applicator carrying one electrode is inserted into tumors percutaneously (or via laparoscopy, or open surgical approaches). Radio Frequency (RF) energy is applied, denaturating and coagulating tissues in a volume of 2cm to 5cm of diameter. Some RFA electrodes are shaped as straight needles; others deploy an umbrella of tines to ablate a larger volume. RFA is attractive as it can be used percutaneously resulting minimally invasive. RFA is a widely accepted cancer treatment therapy, and is applied to primary and secondary tumors in different organs, including liver, lung, kidney, breast, and in musculoskeletal interventions. RFA is often the preferred treatment option for inoperable patients. The typical approach for RFA is percutaneous. Physicians therefore have no direct view of the location of electrodes and of tissues. CT and Ultrasound are used intraoperatively to track the location of electrodes, but both CT and Ultrasound (US) have limited ability to visualize the necrotization of tissues under RFA. It is hard therefore to assess which tissues have been treated and which not. Currently physicians rely on "mental maps" of where they have previously ablated tissues and estimate where to go next. The necrotization volume is also "mentally estimated" from lesion geometry charts provided in print by electrode manufacturers. These charts show the expected ablation geometry for a uniform tissue and do not account for the anatomy or the presence of blood vessels, which can modify and reduce the ablation volume as they transport heat away. The overarching goal of this program is to develop a platform for pre-operative planning and intraoperative RFA guidance, based on simulation of the electrical / thermal effects of RFA and real-time intraoperative prediction of necrotization patterns. Image fusion of RFA simulations onto CT intraoperative images would constitute a guidance system able to show which tissues have been treated and which not, allowing the physicians to properly repositions electrodes and achieve consistent overlap. This would improve outcomes of RFA particularly for patients with tumors greater than 4cm, for which total necrotization has been shown to be particularly hard without guidance.