AView: A Bedside Simulation Tool for Neurovascular Intervention

 描述（由申请人提供）：脑动脉瘤（CA）很难处理，因为其破裂是致命的，破裂率很低，治疗并发症风险很大。美国心脏/卒中协会新的CA管理指南建议临床医生：“在讨论动脉瘤破裂风险时，考虑动脉瘤的形态学和血流动力学特征”。然而，形态测量学和血液动力学需要广泛的工程专业知识来计算。目前，临床医生还没有获得此类指标的工具。通过大学临床和转化研究中心的生物医学工程师与私人医疗保健提供商Gates Vascular Institute的神经外科医生在一栋建筑物中的无缝合作，我们开发了临床软件平台“AView”的原型，用于在床边快速评估患者特定的CA血流动力学和形态学。我们已将该原型进一步部署到8个临床中心，以测试其技术可行性。所有参与的临床医生都热情地接受了这一突破性的工具。所有这些都强调了迫切需要将这样一个工具整合到CA管理的日常临床工作流程中。他们进一步指出，AView的常规临床使用需要最少的手动操作，并提供最大的临床受益。因此，在这笔赠款中，我们希望采取一个飞跃，将AView从目前的原型转变为床边工具，以改善医疗保健。在目标1中，我们将自动化图像分割过程。具体而言，少量种子球将被定位在图像载玻片上，其将在血管内自动居中并自动调整大小。此外，在这个目标中，我们将实现一个治疗计划模块，包括线圈密度计算和支架定位测量。弹簧圈计划工具将指导用户根据特定的填充密度、动脉瘤体积和内置弹簧圈库选择弹簧圈类型和数量。支架计划工具将根据动脉瘤形态、血管几何结构和流入射流指导用户放置支架。在目标2中，我们将使用5例患者特定CA的实验验证AView的形态测量和血流动力学计算。对于形态学验证，我们将比较AView的关键形态学与标准软件的结果。对于血流动力学确认，我们将通过来自相同5个CA的体外和临床数据确认流量计算。我们将比较流动解决方案与粒子图像测速数据从CA phantomy，和流动派生的虚拟血管造影与患者血管造影。该项目的成功完成将使AView成为一个易于使用、影响力大且经过充分验证的床边工具。我们相信AView将彻底改变神经外科医生在床边处理CA的方式。我们对AView的长期愿景是将该工具扩展到每个参与的医疗保健提供者，以促进现场治疗决策和规划。

 DESCRIPTION (provided by applicant): Cerebral aneurysms (CAs) are tricky to manage, since their rupture is deadly, rupture rate is low and treatment complication risk is significant. The new guidelines for CA management by the American Heart/Stroke Association suggest the clinicians: "consider morphological and hemodynamic characteristics of the aneurysm when discussing the risk of aneurysm rupture". However, morphometrics and hemodynamics require extensive engineering expertise to calculate. Currently there is no tool for clinicians to obtain such metrics. Through seamless collaboration between biomedical engineers from University's Clinical and Translational Research Center and neurosurgeons from the private healthcare provider Gates Vascular Institute in one building, we have developed the prototype of a clinical software platform, "AView", for rapid assessment of patient-specific CA hemodynamics and morphometrics at the bedside. We have further deployed this prototype to 8 clinical centers to test its technical feasibility. All participating clinicians enthusiastically embraced this ground-breaking tool. All of them underscored the urgent need of such a tool to be integrated into the day-to-day clinical workflow in CA management. They further indicated that routine clinical use of AView requires to have minimal manual operation and to provide maximal clinical benefits. Therefore, in this grant we would like to take a leap to transform AView from the current prototype into a bedside tool to improve healthcare. In Aim 1, we will automate image segmentation procedure. Specifically, a small number of seed spheres will be positioned on image slides, which will be automatically centered within the vessel as well as automatically resized. Furthermore, in this aim, we will implement a treatment planning module including coil density calculation and stent positioning measurement. Coil planning tool will guide users in choosing type and number of coils based on specific packing density, aneurysm volume and a built-in coil library. Stent planning tool will guide users in stent placement based on aneurysms morphology, vessel geometry and inflow jet. In Aim 2, we will validate the morphometric and hemodynamic calculation of AView using experiments from 5 patient-specific CAs. For morphometric validation, we will compare key morphometrics from AView against the results from standard software. For hemodynamic validation, we will validate flow calculation by in vitro and clinical data from the same 5 CAs. We will compare flow solutions against Particle Image Velocimetry data from CA phantoms, and flow-derived virtual angiography against patient angiography. Successful completion of this project will transform AView into an easy-to-use, high-impact, and well-validated bedside tool. We believe AView will revolutionize the way how neurosurgeons approach CA at the bedside. Our long-term vision of AView is to extend this tool to every participating healthcare provider, in order to facilitate on-site treatment decision- making and planning.