發(fā)布時(shí)間：2018-07-04 15:11

  本文選題：影像融合 + 三維可視化　； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2016年博士論文

【摘要】：影像引導(dǎo)熱消融技術(shù)是肝癌的根治性方法之一,為了進(jìn)一步提高療效和降低局部復(fù)發(fā)率,將具有良好臨床應(yīng)用前景的多模態(tài)影像融合三維可視化導(dǎo)航技術(shù)應(yīng)用于肝腫瘤消融治療的術(shù)前規(guī)劃、術(shù)中導(dǎo)航和術(shù)后評(píng)估是實(shí)現(xiàn)精準(zhǔn)消融的關(guān)鍵。本團(tuán)隊(duì)前期研究已經(jīng)成功將基于電磁定位系統(tǒng)開(kāi)發(fā)的影像融合三維可視化導(dǎo)航平臺(tái)用于術(shù)前科學(xué)規(guī)劃和術(shù)后準(zhǔn)確評(píng)估中,提高了首次治療成功率、降低了治療次數(shù)；對(duì)肝癌消融治療后是否達(dá)到安全邊界的判定也優(yōu)于二維影像,降低了局部腫瘤進(jìn)展率�；谌S可視化技術(shù)的實(shí)時(shí)精準(zhǔn)術(shù)中導(dǎo)航是直接對(duì)患者進(jìn)行消融治療的核心操作。在影像融合三維可視化術(shù)中導(dǎo)航技術(shù)的應(yīng)用方面,本團(tuán)隊(duì)也開(kāi)展了一些相關(guān)的基礎(chǔ)與臨床研究工作,將US與三維CT或MRI影像融合配準(zhǔn)用于引導(dǎo)肝腫瘤的消融治療,積累了初步的經(jīng)驗(yàn)。但也存在一些核心技術(shù)需要進(jìn)一步研究：(1)尚未實(shí)現(xiàn)實(shí)時(shí)三維導(dǎo)航,仍采用二維US結(jié)合三維重建影像引導(dǎo)穿刺；(2)導(dǎo)航坐標(biāo)系配準(zhǔn)采用手工內(nèi)定標(biāo)方式,耗時(shí)且易受干擾,未采用醫(yī)學(xué)影像自動(dòng)識(shí)別技術(shù)實(shí)現(xiàn)導(dǎo)航坐標(biāo)系的自動(dòng)配準(zhǔn)；(3)無(wú)專用的針尖附著式磁導(dǎo)航消融針,不能實(shí)現(xiàn)術(shù)中消融針位置的實(shí)時(shí)監(jiān)控；(4)未解決穿刺導(dǎo)致的臟器和病灶形變以及患者呼吸等運(yùn)動(dòng)導(dǎo)致的臟器和病灶位移對(duì)穿刺準(zhǔn)確性的影響。因此,本團(tuán)隊(duì)與清華大學(xué)和北京理工大學(xué)合作研發(fā)了基于電磁定位系統(tǒng)的、可實(shí)現(xiàn)多模態(tài)影像自動(dòng)融合配準(zhǔn)和實(shí)時(shí)三維可視化導(dǎo)航的微波消融治療肝癌平臺(tái),目前該平臺(tái)采用徒手操作進(jìn)行實(shí)時(shí)三維引導(dǎo)穿刺,今后將與輔助精準(zhǔn)穿刺醫(yī)用機(jī)器人對(duì)接進(jìn)一步提高準(zhǔn)確性并縮短影像引導(dǎo)消融醫(yī)師培訓(xùn)周期。在導(dǎo)航平臺(tái)與醫(yī)用機(jī)器人系統(tǒng)對(duì)接之前,有必要通過(guò)體模及動(dòng)物實(shí)驗(yàn)對(duì)平臺(tái)本身建立全面的精度評(píng)估和驗(yàn)證方法,評(píng)價(jià)其可行性、易操作性和準(zhǔn)確性,為平臺(tái)與醫(yī)用機(jī)器人對(duì)接后系統(tǒng)精度評(píng)估、離活體動(dòng)物實(shí)驗(yàn)研究驗(yàn)證及臨床研究奠定技術(shù)基礎(chǔ)。本研究對(duì)以下三部分的內(nèi)容進(jìn)行了介紹和探討。一、平臺(tái)功能設(shè)計(jì)及磁導(dǎo)航微波針研發(fā)：基于電磁定位系統(tǒng)開(kāi)發(fā)的導(dǎo)航平臺(tái)具有多模態(tài)影像融合和三維可視化術(shù)中導(dǎo)航功能,實(shí)現(xiàn)了影像坐標(biāo)系與磁場(chǎng)坐標(biāo)系的空間快速自動(dòng)配準(zhǔn)和實(shí)時(shí)三維可視化導(dǎo)航穿刺等功能。針尖附著式磁導(dǎo)航微波針是在導(dǎo)航平臺(tái)中實(shí)現(xiàn)肝癌精準(zhǔn)穿刺和消融的關(guān)鍵器械。本團(tuán)隊(duì)與南京康友微波能應(yīng)用研究所合作,研發(fā)了可在NDI磁定位條件下應(yīng)用的磁導(dǎo)航微波針。二、導(dǎo)航平臺(tái)配準(zhǔn)精度評(píng)估：六自由度坐標(biāo)配準(zhǔn)盤(pán)是電磁定位系統(tǒng)中重要的坐標(biāo)配準(zhǔn)硬件工具,為目標(biāo)坐標(biāo)系(CT、US、針具等)建立參考基準(zhǔn),其誤差會(huì)直接影響平臺(tái)配準(zhǔn)精度。本研究使用剛體模型實(shí)驗(yàn)研究對(duì)其空間配準(zhǔn)精度進(jìn)行評(píng)估,證實(shí)了平臺(tái)三維導(dǎo)航平臺(tái)影像與磁場(chǎng)坐標(biāo)系可以實(shí)現(xiàn)準(zhǔn)確的空間自動(dòng)配準(zhǔn)。通過(guò)針尖附著式磁導(dǎo)航微波針與標(biāo)準(zhǔn)針配準(zhǔn)的實(shí)驗(yàn)研究,證實(shí)了平臺(tái)設(shè)計(jì)的導(dǎo)航針具快速配準(zhǔn)功能是準(zhǔn)確可靠的；配準(zhǔn)后的磁導(dǎo)航微波針在磁場(chǎng)中改變位置時(shí),其尖端位置也還會(huì)出現(xiàn)誤差,平均0.31mm-1.17mm,雖然很小,但在動(dòng)物實(shí)驗(yàn)和臨床應(yīng)用術(shù)中導(dǎo)航前應(yīng)把微波針與標(biāo)準(zhǔn)針配準(zhǔn)作為標(biāo)準(zhǔn)操作步驟之一三、導(dǎo)航平臺(tái)穿刺精度評(píng)估：在三種進(jìn)針深度、兩個(gè)分期及三維可視化和二維US兩種引導(dǎo)方式下進(jìn)行穿刺體模實(shí)驗(yàn),通過(guò)兩組操作者的對(duì)比研究,證明了該平臺(tái)的可行性、易操作性和準(zhǔn)確性。三維導(dǎo)航降低了對(duì)操作者經(jīng)驗(yàn)的要求,增強(qiáng)了無(wú)經(jīng)驗(yàn)組完成操作的信心。術(shù)后全部操作者刺中目標(biāo)的準(zhǔn)確率為88.9%(48/54)。通過(guò)對(duì)三維可視化和影像融合容積導(dǎo)航引導(dǎo)穿刺離體豬肝的動(dòng)物實(shí)驗(yàn)對(duì)比研究,證實(shí)了該平臺(tái)在配準(zhǔn)時(shí)間、穿刺時(shí)間和穿刺誤差方面與商用的影像融合容積導(dǎo)航軟件平臺(tái)(Volume Navigation, GE公司LOGIQ E9彩色多普勒超聲儀配置)無(wú)差異,建立了三維可視化導(dǎo)航平臺(tái)精度驗(yàn)證和定量評(píng)估的動(dòng)物實(shí)驗(yàn)方法,穿刺的平均誤差為1.64士1.30mm�？傊�,本研究對(duì)三維可視化導(dǎo)航平臺(tái)可行性、易操作性和準(zhǔn)確性進(jìn)行了評(píng)估,為三維可視化導(dǎo)航平臺(tái)的活體動(dòng)物實(shí)驗(yàn)研究驗(yàn)證及臨床研究建立了全面的精度檢測(cè)和定量分析方法,為今后平臺(tái)與輔助精準(zhǔn)穿刺醫(yī)用機(jī)器人的對(duì)接奠定了技術(shù)基礎(chǔ)。
[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.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.7

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