Cone-beam CT (CBCT) offers an important new modality for image-guided interventions. Its implementation on a mobile C-arm presents an opportunity to develop a high-performance intraoperative imaging and guidance system and investigate the benefits to surgical performance in challenging interventional tasks. In head and neck (H&N) surgery, infiltrative disease within a complex environment of critical structures (e.g., the optic nerves, carotid arteries and brain) poses a major challenge to surgical performance in the absence of intraoperative imaging. While conventional image-guided surgery (IGS) using real-time tracking and navigation relative to preoperative images has offered an important advance, its value is largely limited to resection of bony neoplasms in the context of rigid (non-deforming) skeletal anatomy. A broad spectrum of H&N surgeries - particularly those targeting soft-tissue lesions with deformation likely in the course of therapy (e.g., herniation of orbital and intracranial structures) - requires intraoperative imaging to reap the full benefit of IGS. We hypothesize that intraoperative CBCT offering sub-mm 3D spatial resolution and soft-tissue visibility will maximize surgical performance in target ablation, minimize complications to critical structures, and extend the applicability of IGS across the full range of H&N interventions. We propose to develop, characterize, and deploy a high-performance image guidance system based on C-arm CBCT as follows: 1.) Develop a fully integrated surgical guidance system based on C-arm CBCT, realtime tracking, and 3D deformable image registration;2.) Quantitatively evaluate the benefits to surgical performance in challenging interventional tasks, including ethmoid sinus ablation, trans-sphenoid approach to the CNS, and skull base lesion excision;and 3.) Investigate system performance in pre-clinical deployment in patient studies under research protocol, including multi-modality intraoperative CBCT and MRI. High-performance IGS bas ed on intraoperative CB CT offers to: i.) improve surgical performance (maximize sensitivity and specificity in the ablation of challenging targets);ii.) expand the application of surgery to cases that would be conventionally inoperable;and iii.) support the development of novel surgical therapeutics (e.g., robot-assisted surgery, photodynamic therapy, and precise targeting using chemical or biological agents) that require a high degree of geometric precision provided by intraoperative imaging.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA127444-04
Application #
7892562
Study Section
Biomedical Imaging Technology Study Section (BMIT)
Program Officer
Farahani, Keyvan
Project Start
2007-09-04
Project End
2012-07-31
Budget Start
2010-08-31
Budget End
2012-07-31
Support Year
4
Fiscal Year
2010
Total Cost
$311,600
Indirect Cost
Name
Johns Hopkins University
Department
Biomedical Engineering
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Liu, Wen P; Reaugamornrat, Sureerat; Sorger, Jonathan M et al. (2015) Intraoperative image-guided transoral robotic surgery: pre-clinical studies. Int J Med Robot 11:256-67
Liu, Wen P; Richmon, Jeremy D; Sorger, Jonathan M et al. (2015) Augmented reality and cone beam CT guidance for transoral robotic surgery. J Robot Surg 9:223-33
Chan, Harley H L; Siewerdsen, Jeffrey H; Vescan, Allan et al. (2015) 3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling. PLoS One 10:e0136370
Reaungamornrat, S; Wang, A S; Uneri, A et al. (2014) Deformable image registration with local rigidity constraints for cone-beam CT-guided spine surgery. Phys Med Biol 59:3761-87
Yoo, J; Schafer, S; Uneri, A et al. (2013) An electromagnetic ""Tracker-in-Table"" configuration for X-ray fluoroscopy and cone-beam CT-guided surgery. Int J Comput Assist Radiol Surg 8:1-13
Mirota, Daniel J; Uneri, Ali; Schafer, Sebastian et al. (2013) Evaluation of a system for high-accuracy 3D image-based registration of endoscopic video to C-arm cone-beam CT for image-guided skull base surgery. IEEE Trans Med Imaging 32:1215-26
Dmytriw, A A; Witterick, I J; Yu, E (2013) Endoscopic resection of malignant sinonasal tumours: current trends and imaging workup. OA Minim Invasive Surg 1:
Uneri, Ali; Nithiananthan, Sajendra; Schafer, Sebastian et al. (2013) Deformable registration of the inflated and deflated lung in cone-beam CT-guided thoracic surgery: initial investigation of a combined model- and image-driven approach. Med Phys 40:017501
Liu, Wen P; Reaugamornrat, Sureerat; Deguet, Anton et al. (2013) Toward Intraoperative Image-Guided Transoral Robotic Surgery. J Robot Surg 7:217-25
Reaungamornrat, S; Liu, W P; Wang, A S et al. (2013) Deformable image registration for cone-beam CT guided transoral robotic base-of-tongue surgery. Phys Med Biol 58:4951-79

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