Enhanced tumour localization, visualization, resection and radiotherapy in computer-aided surgery: Assisting surgeons via robotics and augmented-reality image-overlay technologies

对于早期乳腺癌，治疗选择包括完全切除乳房的乳房切除术和仅切除肿瘤和部分邻近组织的肿块切除术(保乳手术)。由于包括美容在内的许多因素，肿块切除术经常受到女性的青睐。由于乳房高度变形，外科医生很难在手术过程中根据术前乳房X光/超声图像跟踪肿瘤的位置、方向和形状。当可以触摸到乳腺肿瘤时，也就是说，外科医生的手可以感觉到它，进行肿块切除术相对简单。然而，当肿瘤无法触及时，外科医生必须依靠术前植入乳房的导丝来标记肿瘤的位置，从而进行手术。这种不精确的方法无法清楚地为外科医生识别无法触及的肿瘤，并导致重复手术，从而降低了肿块切除术的美容效果，并可能推迟乳腺癌的补充治疗。这些挑战可以通过更好的肿瘤定位和可视化来缓解。我们提出了一种基于机器人和增强现实的外科医生辅助解决方案，使用基于超声图像的肿瘤发现和跟踪算法以及增强现实肿瘤可视化算法来计划和执行乳腺肿块切除术。增强现实显示器将通过将肿瘤的图像叠加在患者的身体乳房上，以不引人注目和直观的方式在视觉上引导外科医生到达肿瘤位置。这项技术将使外科医生能够更准确地计划和执行肿块切除术。我们的低成本解决方案提高了病变定位/可视化的准确性，缩短了手术时间，并增强了外科医生的情况意识，同时增强了患者肿块切除术后的乳房美容。

For early-stage breast cancer, treatment options include mastectomy in which the breast is fully removed and lumpectomy (breast-conserving surgery) in which only the tumour and a portion of the adjacent tissue are removed. Lumpectomy is often preferred by women for a number of factors including cosmesis. Since the breast is highly deformable, it is difficult for the surgeon to keep track of the tumour location, orientation and shape during surgery based on preoperative mammogram/ultrasound images. When a breast tumour is palpable, i.e., it can be felt by the surgeon's hand, performing lumpectomy is relatively straightforward. When the tumour is impalpable, however, the surgeon must perform the surgery by relying on a guidewire implanted preoperatively into the breast for marking the tumour location. This imprecise way fails to clearly identify an impalpable tumour for the surgeon and causes repeat surgeries that reduce the cosmetic benefits of lumpectomy and may delay supplemental treatments for breast cancer. These challenges can be mitigated with better localization and visualization of tumours. We propose a robotics and augmented reality-based surgeon-assist solution to the issues of planning and executing breast lumpectomy using algorithms for ultrasound image-based tumour finding and tracking and augmented-reality tumour visualization. The augmented-reality display will visually guide the surgeon to the tumour location in an unobtrusive and intuitive manner by overlaying an image of the tumour on the patient's physical breast. This technology will enable surgeons to more accurately plan and execute lumpectomy. Our low-cost solution improves the accuracy in lesion localization/visualization, reduces the procedure length, and enhances the surgeon's situational awareness while enhancing post-lumpectomy breast cosmesis for patients.