計(jì)算機(jī)輔助外科技術(shù)

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NSFEngineeringResearchCenterfor

Computer-IntegratedSurgicalSystems

fandTechnology

CISSTResearchProgram:

CurrentandFutureTrends

GregoryD.Hager

AssociateDirectorforResearch

CISSTERC

JohnsHopkinsUniversity

3400N.CharlesStreet,Baltimore,Md.21218

hager@

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

NSFEngineeringResearchCenter

forComputer-IntegratedSurgical

SystemsandTechnology

?Established1998

?Multi-institution,multi-disciplinarycenter

-JohnsHopkinsUniversity+MedicalInstitutions

-MIT+Brigham&Women5sHospital

-CMU+UPMC

—Others：MorganState,Georgetown,Harvard,Penn,Columbia

?Funding

一CoreNSFGrant+NIH+Industry;Total=$9-1OM

?Universityresearchers,clinicians,industry

?Research,Systems,Education,Outreach

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

CISSTPremise

Theimpactofcomput

integratedsurgical

systemsandtechnology

onmedicalcareinthe

next20yearswillbeas

greatastheimpactof

computer-integrated

manufacturingsystems

andtechnologyon

industrialproductionover

thepast20years.

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnofog*

CISSystemsVision

PreoperativeIntraoperative

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

Computer-

Patient-specific

Model

Execution

Patient

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

SurgicalCAD-CAMActivities

Spine

ProstateLiver

Metastasisfrom$120billioncost

200,000cancers/yearcolorectalcancer70%ofpopulation

1Mbiopsies/year130,000new/yearaffectedinlifetime

10MBPHcurrently60,000death/yearBone

25%ofmenaffectedinHepatitisworldwide

lifetime400,000metastatic

cases/year

UnitedStatesnumbers

Whythese?

?Significanthealthproblems

?Clinicalcollaboration

?Experience

?Externalfunding

?Suitablemixforprototyping

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

Preoperativentraope

Computer-ateM

assisted

planning

Patient-specific[

Model?

Postoper

Assisted

Assessment

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

SurgicalAssistanceActivities

EyeEarSinusThroatBrainGeneralMIS

Hager,OkamuraTaylorOkamura,Hager

EngineeringTaylorTaylor

Riviere.Cole-WhitcombKazanzidesTaylor,Kanade

FacultyHagerSimaan

Rhodes,Etienne-HagerRiviere,

Okamura

CummingsRiviereKazanzides

HandaRothbaumYuh,Gott

ClinicalLong

HumayenFrancisIshiiFlintTalamini

FacultyClatterbuck

DeJuanChoti

Engh

ThompsonMarohn,Hanly

TremorreductionAdvancedHighdexterityIntegrationofTelesurgeryand

PrincipalAccessingthe

andimage-basedvisualizationinconfinedNavigationandhumanfactors/

FocusScala-Media

guidancewithSHRspacesRoboticsRobot-assisted

guidanceNeedlesteeringultrasound

NewJHU

JHUSHRwithIntuitiveSurgical

JHUSHRwithsnakedesign,JHUSHR,

adaptedDohenyEndActivedaVincisystem

PlatformspecialdeliveryIntuitiveMedtronic

EyeInstituteendoscope

systemSurgicaldaStealthstation

cannulaeCMULarsUltrasound

VincisystemSteeredNeedle

Micronwithsamerobot

Tasks2,eventually1,1,eventually2,

1,2,3,4112,3,4

Involved3and43,4

PhantomtrailsNewdeliverySystem

ClinicalCadaverand

(Micron,SHR)systemunderPhantomtrialsdevelopment/

StatusPhantomtrialsPhantomtrials

ongoingdevelopment.infrastructure

inAugust

underway

NIHR01(Micron)PittsburghNIHR01,SBIR

External

NIHR21SubmittedSeekingNIHNIHR21underFoundationP1,Whitaker,

Funding

(Image-guidedfundingrevisionNIHR21ABC2pendingNSF

Status

Micron)NIHR21/33OtherNIH,Army

PlannedNIH(SHR)pendingpending

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

TheSpectrumofCISSystems

Patienl

PostoperativePatient

Modeling&AnalysisInterfaceTechnology

?SegmentationSystems?Sensing

?Registration?Safety&verifiability?Robotics

?Atlases?Usability&maintainability?Human-machine

?Optimization?Performanceandvalidationinterfaces

?Visualization

Modeling&Analysis

?Real-timeregistration

InterfaceTechnology?Visualization

?Robotics?Taskcharacterization

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

CISSTResearchOrganization

Thrust1Thrust2

SurgicalSurgical

AssistantsCAD/CAM

Barrier1

Modeling

and

Analysis

Barrier2Thrust0

InterfaceEngineering

Technology

Infrastructure

Barrier3

Systems

Science

PlannedCISSTSystemsEvolution

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

199

Engineered

Systems&

Applications

Enablingcore

technology

Fundamental

Knowledge

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

2005

Engineered

Systems&

---------------1

EnablingcoreR\__廣

technology

Fundamental號

KnowledgeHe%

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

CISSTResearchDevelopedthrough

clinicalandindustrial

ProgramTodaycollaborations

pplication

Clinical

Systems

ResearchTechnology

Thetranslationof

Createdbasedon

basicresearch

applicationneeds

intopractice

QF■

Thebasisforarich,self-sustainingprogramofbasicand

appliedresearch,andacademicandindustrialcollaboration

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

FutureTrends

?Combineimaging,visualizationandactionintheOR

-Multi-modalregistration,intra-operativeimaging,statistical

atlases

-In-scannerrobots

一Real-timeUScalibrationand3Delastography

?Novelinstruments/sensorsforspecificapplications

一Micron(CamRiviere,CMU)

一Scalablesnakerobot

-HeartLander(CamRiviere,CMU)

?Real-timeinformationupdateandassistance

-Virtualfixturesforsafetyandguidance

-Novelinstrumentsandsensorysubstitution

-ContextAwareSurgicalAssistance(CASA)

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

SurgicalCAD-CAM:Motivation

ProstateCancer

?1Millionprostatebiopsiesannually

?230,000newcases

?30,000deathsinU.S.in2004

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

CurrentPractice

ClinicalStandard:Ultrasoundguidedbiopsy

?Poortissuecontrast

?'Blind'systematicbiopsyofthegland(6-12samples)

?Falsenegative20-30%

?GleasonscoreonUSbiopsyof25%ofpatients

isbeing'upgraded'attimeofsurgery

AdvantagesofMRI:

?MRIwithendo-rectalcoilhasexcellentsensitivityfordetecting

tissueabnormalitiesandmayallowfortargeted5biopsy.

?HighSNRimprovesdiagnosticaccuracy,especiallyforMRSI

andDCE-MRL

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

MRI-GuidedProstateInterventions

ApexAnterio

,■

;Posterim

Left?Right

?Base

DeformableProstate

Atlas(Davatzikos,Shen)

DeformableFusion

Signalcorrection(Kikinis,Warfield)

(Warfield)

ProstateSegmenter

(Wells,Grimson)

QuickTime?anda

TIFF(LZW)decompressor

areneededtoseethispicture.

Planning(DiMaio,Fichtinger)

NeedleTracking(DiMaio)

3TProstateRobot(Whitcomb

IMRTRobot(Chinzei,

EngineeringResearchCenterforCompuFichtinger,Atalar,etal.)

MRIGuidedProstateInterventions

A.Krieger1R.C.Susil3,CynthiaMenard5,

JonathanColeman6,AnuragSingh5,

L.L.Whitcomb1,E.Atalar2,G.Fichtinger24

1DepartmentofMechanicalEngineering

2DepartmentofRadiology

3DepartmentofBiomedicalEngineering

4CISSTEngineeringResearchCenter

JohnsHopkinsUniversity,Baltimore,MD

JERCICISST

J1ONAU

5RadiationOncologyBranch,NCI-NIH-DHHS\NCER

6UrologicOncologyBranch,NCI-NIH-DHHSriTUTH

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnologyg

OverallSystem

.Manipulator

2.Tracking

Svstem>

Position3.Visualizationand

Parameters

TargetingProgram

Digital

Images

PhysicianInterface

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnologyg

Manipulator

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

Simulation

QuickTime?anda

YUV420codecdecompressor

areneededtoseethispicture.

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

VisualizationandTargetingProgram

EngigResearchCenteHorComputermegratedSu麗SystemsandT-gyf

Results

ClinicalTrialsunder1.5Tand3T

?Goldmarkerseedplacements

Implantationof4goldmarkerseedsto

guideexternalradiationbeamtherapy.

16patientswith4seedimplantseach

?Biopsies

15patientswith4-10biopsieseach

?Nosevereadverseevents

?Averagetargetingaccuracybetween2.8mmand7.4mm

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

MRimaqesdurin。aclinicalprocedure:

Left:Atarget(reddot)isselectedonanaxialTSET2-weightedimage.

Middle:TheneedletipvoidisvisualizedinanaxialTSEProtonDensityimage.

Thedesiredtargetmatchestheactualpositionoftheneedle.

Right:TheneedlevoidisvisualizedonasagittalTSEProtonDensityimage,

CurrentandFutureWork

RedesignoftheProstateInterventionalSystem

?Fasterproceduretime

?Easyimplementationwithdifferentscannerarchitectures

Improvementsinclude:

?Steerableneedleguide

?Newtrackingscheme

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

SteerableNeedles

A.Okamura,N.Cowan,G.Chirikjian,K.T.DeWeese,K.Murphy

/publications/iser04-webster.pdf

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

SteerableNeedleGuideDesign

WheelforWheelfor

toMountHelicalCut

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

NewTrackingScheme

Combinationof

?PassiveTrackingforinitialregistration

?OpticalEncodersforrotationandneedleangle

CodeWheelforPassiveMarker

codingofRotationTubes

CodeWheelfor

EncodingofNeedle

GuideAngle.jchnologyg

USGuidedProstateInterventions

RegistrationofUltrasoundtoFluoroscopy

?SBIRPhase-1

?DoDClinicaltrialaward

?Burdette/fellowship

?SBIRPhase-2(pending)

?SPOREsupplement(pending)

?DoDfellowship(pending)

?R21(pending)

?IRB/clinicaltrialapproved

RoboticBrachytherapy

TransrectalUSAblation

?SBIRPhase-1TRUSGuidedBrachytherapy

?SBIRPhase-2(BurdetteMedicalSystems)

?IRB/clinicaltrialapproved

AtlasBasedUSBiopsy

?STTRPhase-1

kPi/slerit?Burdette/fellowship

"Right

RO1--atlas

RO1-segmentation(pending)

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

Example:Atlas-based,image-guidedprostatebiopsy

DetectionRateof>99%!

Comparedto77%usingstandardmethods

PeformableSegmentation^

ofProstateImages/

Facultymembers:D.Shen,C.

MRIprostateimageDavatzikos,C.Tempany,G.

Fichtinger,S.Haker

Engineenng4^esearTHi-<}errter-fareornpirterIntegratedSurgicalSystemsandTechnology

,2005I

Example:BiomechanicalSimulation

ofMedicalNeedleInsertion

RonAlterovitz,KenGoldberg(UCBerkeley)

JeanPouliot,l-ChowHsu(UCSF)

?Goal'.Reduceradioactiveseedplacementerrorinprostatecancer

brachytherapytreatmentusingbiomechanicalsimulation

?Developed2Ddynamicfiniteelementmodelofneedleinsertionintissue

?Interactivesimulation:24fpsona750MHzPC

?Applications:Physiciantrainingandtreatmentplanning

QuickTime?andaQuickTime?anda

YUV420codecdecompressorYUV420codecdecompressor

areneededtoseethispicture.areneededtoseethispicture.

TissuedeformationscauseseedPlannercomputesoffsetstocompensate

placementerrorforsimulatedtissuedeformations

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

Robot-AssistedUS-GuidedLiverTherapy

Ultrasound

system

Surgicalworkstation

UltrasoundAblationN

RobotrobotM

□Rk

JHMI:Choti(Sura),Kavoussi(Urology),Solomon(Radiology)

WSE:Fichtiger,Taylor,Boctor,Jain,Fischer,Vishwanathan,etal.

Industry:BurdetteMedical,IntuitiveSurgical,Aloka,Siemens

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnology

Averageerror

for10trials

?3mm

Mainlimitation

wasEMtracker

Credit:Boctor,

Fichtinger,

Vishwanathan,

Fischer,Taylor,

Jain,Choti,etal.

EngineeringResearchCenterforComputerIntegratedSurgicalSystemsandTechnologyg

In-VivoUltrasoundCali

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