Cycle II 2010-2015
In recent years, the target organs for image-guided therapy (IGT) have evolved from rigid organs, such as the skull and spine, to other semi-rigid but static organs, such as the prostate. Recent literature and our preliminary studies reveal an emerging and exciting potential to expand IGT to moving or deforming organs. However, the delivery of IGT to these organs continues to be hampered by the lack of appropriate methods to track organ motion or to synchronize surgical tools to the moving target. The IGT research community also lacks engineering methods to integrate an intraoperative imager with research computers, leading us to repeat engineering resource investments for system integration.
Our long-term goal is to perform IGT of dynamically moving organs by capturing motion-related physical and physiological changes and accurately delivering novel minimally invasive tools. The objective of this Technology and Research Development project is to develop engineering methods to integrate and display streaming images from the imaging device, model organ motion from the images, and enable new IGT of moving organs. We continue to base our research in the use of free open source software, 3D Slicer, as a navigation platform to optimize interactions with both internal and external collaborators and to facilitate easy dissemination of our results to other sites, including other NIH-funded studies.
Specific Aim 1: To develop and clinically validate image-registered endoscopic ultrasound with improved accuracy and new applications. We will improve the performance of gastroscopic ultrasound for guiding cannula placement in the pancreas to enable more precise fine needle aspiration or biopsy. A 3D Slicer-based image-registered endoscopic ultrasound system with improved registration, segmentation, display, and tracking capabilities will be evaluated in a series of clinical studies. We will extend the applications for image registration by demonstrating new applications in adjacent structures such as the adrenal glands, biliary tree, and kidneys in human subjects.
Specific Aim 2: To develop intra-cardiac beating heart surgery aided by three-dimensional (3D) ultrasound image guidance. We will develop and demonstrate surgical navigation software to allow 3D ultrasound-guided intra-cardiac beating heart surgery. We will develop software tools to integrate the 3D ultrasound scanners with 3D Slicer and perform 3D fast volume rendering of streaming ultrasound images. We will develop a method to timestamp the ultrasound images acquired from the imagers and tracked surgical devices and display them in 3D Slicer with precise synchronization and minimum latency. We will do a phantom study to validate the working hypothesis that the proposed surgical guidance software will increase the efficacy of ultrasound-guided mitral valve repair.
Specific Aim 3: To perform MR-guided ablation of the liver with motion-compensated navigation. We will develop and test surgical navigation software to assist in MR-guided tumor ablation of the liver. The major effort will be directed to providing motion correction tools. Based on our preliminary studies on four-dimensional (4D) MRI, we will develop a method to preoperatively model subject-specific motion of the liver. We will model subject-specific motion of the liver by acquiring 4D MRI and displaying the predicted position of the liver and tumor at any given phase in the respiratory cycle using optical markers attached to the patient’s skin. We will integrate the organ motion estimation model in 3D Slicer and test and validate this method of motion-compensation in MR-guided cryoablation of the liver. The proposed study in this aim directly responds to the emerging needs of the driving biological projects (PI: Cleary, R01CA124377) associated with this Guidance Technology and Research Development project.
The proposed studies are significant since the scientific and engineering methods developed in each of the specific aims will enable innovative clinical interventions that would otherwise not be possible. Namely, these new surgical procedures are (i) transluminal endoscope therapy using image-registered endoscopic ultrasound, (ii) intra-cardiac beating heart surgery of the mitral valve using fast volume rendering of streaming 3D ultrasound images, and (iii) MRI-guided cryotherapy of the liver with organ motion compensation. Success in meeting these aims will produce robust, multi-platform, open source surgical navigation software. The proposed study will make a major impact in engineering and clinical science, since this software can be applied to clinical cases in our institution as well as to other NIH-funded collaborators to demonstrate the efficacy of these approaches compared to the current standard of care to enable further novel IGT procedures.
- Fernández-Esparrach G., San José Estépar R., Guarner-Argente C., Martínez-Pallí G., Navarro R., Rodríguez de Miguel C., Córdova H., Thompson C.C., Lacy A.M., Donoso L., Ayuso-Colella J.R., Ginès A., Pellisé M., Llach J., Vosburgh K.G. The Role of a Computed Tomography-based Image Registered Navigation System for Natural Orifice Transluminal Endoscopic Surgery: a Comparative Study in a Porcine Model. Endoscopy. 2010 Dec;42(12):1096-103. PMID: 20960391.
- Elhawary H., Oguro S., Tuncali K., Morrison P.R., Tatli S., Shyn P.B., Silverman S.G., Hata N. Multimodality Non-rigid Image Registration for Planning, Targeting and Monitoring during CT-guided Percutaneous Liver Tumor Cryoablation. Acad Radiol. 2010 Nov;17(11):1334-44. PMID: 20817574. PMCID: PMC2952665.
Cycle I 2005-2010
The Guidance Core began in Cycle II of the NCIGT.