三维可视化导航经皮微波消融治疗肝癌的实验研究

发布时间：2018-07-04 15:11

本文选题：影像融合 + 三维可视化　；参考：《中国人民解放军医学院》2016年博士论文

【摘要】：影像引导热消融技术是肝癌的根治性方法之一,为了进一步提高疗效和降低局部复发率,将具有良好临床应用前景的多模态影像融合三维可视化导航技术应用于肝肿瘤消融治疗的术前规划、术中导航和术后评估是实现精准消融的关键。本团队前期研究已经成功将基于电磁定位系统开发的影像融合三维可视化导航平台用于术前科学规划和术后准确评估中,提高了首次治疗成功率、降低了治疗次数；对肝癌消融治疗后是否达到安全边界的判定也优于二维影像,降低了局部肿瘤进展率。基于三维可视化技术的实时精准术中导航是直接对患者进行消融治疗的核心操作。在影像融合三维可视化术中导航技术的应用方面,本团队也开展了一些相关的基础与临床研究工作,将US与三维CT或MRI影像融合配准用于引导肝肿瘤的消融治疗,积累了初步的经验。但也存在一些核心技术需要进一步研究：(1)尚未实现实时三维导航,仍采用二维US结合三维重建影像引导穿刺；(2)导航坐标系配准采用手工内定标方式,耗时且易受干扰,未采用医学影像自动识别技术实现导航坐标系的自动配准；(3)无专用的针尖附着式磁导航消融针,不能实现术中消融针位置的实时监控；(4)未解决穿刺导致的脏器和病灶形变以及患者呼吸等运动导致的脏器和病灶位移对穿刺准确性的影响。因此,本团队与清华大学和北京理工大学合作研发了基于电磁定位系统的、可实现多模态影像自动融合配准和实时三维可视化导航的微波消融治疗肝癌平台,目前该平台采用徒手操作进行实时三维引导穿刺,今后将与辅助精准穿刺医用机器人对接进一步提高准确性并缩短影像引导消融医师培训周期。在导航平台与医用机器人系统对接之前,有必要通过体模及动物实验对平台本身建立全面的精度评估和验证方法,评价其可行性、易操作性和准确性,为平台与医用机器人对接后系统精度评估、离活体动物实验研究验证及临床研究奠定技术基础。本研究对以下三部分的内容进行了介绍和探讨。一、平台功能设计及磁导航微波针研发：基于电磁定位系统开发的导航平台具有多模态影像融合和三维可视化术中导航功能,实现了影像坐标系与磁场坐标系的空间快速自动配准和实时三维可视化导航穿刺等功能。针尖附着式磁导航微波针是在导航平台中实现肝癌精准穿刺和消融的关键器械。本团队与南京康友微波能应用研究所合作,研发了可在NDI磁定位条件下应用的磁导航微波针。二、导航平台配准精度评估：六自由度坐标配准盘是电磁定位系统中重要的坐标配准硬件工具,为目标坐标系(CT、US、针具等)建立参考基准,其误差会直接影响平台配准精度。本研究使用刚体模型实验研究对其空间配准精度进行评估,证实了平台三维导航平台影像与磁场坐标系可以实现准确的空间自动配准。通过针尖附着式磁导航微波针与标准针配准的实验研究,证实了平台设计的导航针具快速配准功能是准确可靠的；配准后的磁导航微波针在磁场中改变位置时,其尖端位置也还会出现误差,平均0.31mm-1.17mm,虽然很小,但在动物实验和临床应用术中导航前应把微波针与标准针配准作为标准操作步骤之一三、导航平台穿刺精度评估：在三种进针深度、两个分期及三维可视化和二维US两种引导方式下进行穿刺体模实验,通过两组操作者的对比研究,证明了该平台的可行性、易操作性和准确性。三维导航降低了对操作者经验的要求,增强了无经验组完成操作的信心。术后全部操作者刺中目标的准确率为88.9%(48/54)。通过对三维可视化和影像融合容积导航引导穿刺离体猪肝的动物实验对比研究,证实了该平台在配准时间、穿刺时间和穿刺误差方面与商用的影像融合容积导航软件平台(Volume Navigation, GE公司LOGIQ E9彩色多普勒超声仪配置)无差异,建立了三维可视化导航平台精度验证和定量评估的动物实验方法,穿刺的平均误差为1.64士1.30mm。总之,本研究对三维可视化导航平台可行性、易操作性和准确性进行了评估,为三维可视化导航平台的活体动物实验研究验证及临床研究建立了全面的精度检测和定量分析方法,为今后平台与辅助精准穿刺医用机器人的对接奠定了技术基础。
[Abstract]:Imaging guided thermal ablation is one of the radical methods for the liver cancer. In order to further improve the curative effect and reduce the local recurrence rate, the multi-modal image fusion three-dimensional visualization navigation technology with good clinical application is applied to the preoperative planning of liver tumor ablation treatment. The navigation and postoperative evaluation of intraoperative navigation are the key to achieve accurate ablation. In previous studies, the team has successfully applied the 3D visualization navigation platform based on the development of electromagnetic positioning system for pre operation scientific planning and postoperative accurate evaluation to improve the first treatment success rate and reduce the number of treatment; the decision to reach the safe boundary of the liver cancer after ablation treatment is also superior to the two-dimensional image. In the application of navigation technology in 3D visualization of image fusion, the team has also carried out some relevant basic and clinical research work to integrate US with 3D CT or MRI images. Preliminary experience has been accumulated to guide the ablation treatment of liver tumor. But there are some key technologies that need further research: (1) the real-time three-dimensional navigation is not yet realized, and two-dimensional US is still used to guide the puncture with three-dimensional reconstruction images; (2) the navigation coordinate system is registered with manual internal calibration method, time consuming and easily disturbed, and no medical use. Automatic image recognition technology realizes automatic registration of navigation coordinate system; (3) no special needle tip attachment magnetic navigation needle can not realize real-time monitoring of the position of ablation needle during the operation; (4) the influence of the displacements and displacements of the organs and lesions caused by the movement of the patient's respiration on the accuracy of the puncture. This team, in collaboration with Tsinghua University and Beijing Institute of Technology, developed a microwave ablation treatment platform based on electromagnetic positioning system, which can achieve multi-modal image fusion registration and real-time three-dimensional visualization navigation. At present, the platform uses bare hands to carry out real-time three-dimensional guided puncture and will be assisted with accurate puncture medical treatment in the future. Robot docking further improves accuracy and shortens the training cycle of radiofrequency ablation physicians. Before docking the navigation platform and medical robot system, it is necessary to establish a comprehensive accuracy evaluation and verification method by body model and animal experiment to evaluate the feasibility, operability and accuracy of the platform and medical machines. The following three parts are introduced and discussed in this study. First, platform function design and magnetic navigation microwave needle research and development: the navigation platform based on the electromagnetic positioning system has multi-modal image fusion and 3D visualization. The function of the navigation is to realize the function of rapid automatic registration of the image coordinate system and the magnetic field coordinate system and the real-time three-dimensional visualization navigation puncture. The needle tip attached magnetic navigation microwave needle is the key instrument for accurate puncture and ablation of liver cancer in the navigation platform. The team is working with the Nanjing Kang friend microwave energy application research institute. The magnetic navigation microwave needle can be used in the NDI magnetic positioning condition. Two, the registration accuracy evaluation of the navigation platform: the six degree of freedom coordinate registration disk is an important coordinate registration hardware tool in the electromagnetic positioning system. The reference frame is set up for the target coordinate system (CT, US, needle etc.). The error will directly affect the registration accuracy of the platform. The accuracy of space registration is evaluated by the body model experiment. It is proved that the 3D navigation platform image and the magnetic field coordinate system can achieve accurate and automatic registration. Through the experimental study of the registration of the magnetic navigation microwave needle and the standard needle, it is proved that the rapid registration function of the platform designed navigation needle is accurate and reliable. When the registration of magnetic navigation microwave needle changes the position in the magnetic field, the position of its tip will also have error, the average 0.31mm-1.17mm, although very small, but before navigation in animal experiment and clinical application, the registration of the microwave needle and the standard needle should be one of the standard operation steps three. The accuracy evaluation of the navigation platform puncture: in the three kinds of needle Depth, two staging and three-dimensional visualization and two-dimensional US two types of guided puncture experiments, through the comparison of two groups of operators, the feasibility, operability and accuracy of the platform is proved. Three-dimensional navigation reduces the requirements of the operator's experience, enhances the confidence of the inexperienced group to complete the operation. All operation after the operation The accuracy rate of the target was 88.9% (48/54). Through the comparative study on the animal experiments of the porcine liver which was guided by the three-dimensional visualization and image fusion volume navigation, it proved that the platform was used for the registration time, the puncturing time and the puncture error, and the Volume Navigation, the GE company LOGIQ E9. There is no difference in the collocation of color Doppler ultrasound apparatus. An animal experiment method for accuracy verification and quantitative evaluation of three-dimensional visualization navigation platform is established. The average error of the puncture is 1.64 1.30mm.. The feasibility, maneuverability and accuracy of the 3D visualization navigation platform are evaluated, and it is the living body of the three-dimensional visualization navigation platform. In animal experimental research and clinical research, a comprehensive method of precision detection and quantitative analysis has been established, which lays a technical foundation for the docking of the platform and the auxiliary accurate puncture medical robot in the future.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R735.7

【相似文献】