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Platform Technology for Multiple IGT applications

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da Vinci. Salient Feature. Patch. Applications of TGT. Intracranial Neurosurgery. Tumor resection ... Orion Code Base drives: (2) Colorectal Cancer Staging and ... – PowerPoint PPT presentation

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Title: Platform Technology for Multiple IGT applications


1
Platform Technology for Multiple IGT applications
  • Robert L. Galloway Jr., PhD
  • Professor of Biomedical Engineering
  • Professor of Neurosurgery
  • Professor of Surgery
  • Director, Center for Technology-Guided Therapy
  • Vanderbilt University

2
Disclosure
Bob Galloway is the founder of , and retains an
equity position in, Pathfinder Therapeutics Inc,
of Nashville, TN
3
Technology-Guided Therapy
Mechanical Data
Thermal Data
Optical Data
Neuroprosthesis
Radiation Therapy
Surgical Resection
Ablation Tech niques
Ortho pedics
External Beam Radiation
Intra- Operative Imaging
Image-Guided Surgery
Preoperative Images
Image-Guided Procedures
Image-Guided Interventions
Tissue Models
Gene Therapy
4
History of Image-Guided Therapy
  • 1896 J.H. Clayton. X-Ray use in surgery
  • 1904 Horsley and Clarke. Stereotactic frame
  • 1946 Spiegel and Wycis. Stereotactic frame using
    xrays.
  • 1940s1950s Leksell, Riechert-Mundinger,
    Talairach, Cooper...

TGT
5
Technology-Guided Therapy Timeline
  • 1986
  • Roberts et al. A frameless stereotaxic
    integration of computerized tomographic imaging
    and the operating microscope, J. Neurosurg, 65,
    545, 1986.
  • 1987
  • A three dimensional guidance system for
    stereotactic neurosurgery. Proposal to the
    Whitaker Foundation RL Galloway PI
  • Watanabe et al. Three-dimensional digitizer
    (neuronavigator) new equipment for computed
    tomography-guided stereotaxic surgery
    Surg-Neurol, 27, 1987

6
Technology-Guided Therapy Timeline
  • 1997 (Vanderbilt)
  • Discussions begin about applying IIGS techniques
    to other organs
  • Discussions begin about software redesign (Orion)
  • Abstract the TGT process
  • Software Architecture
  • Speed of Performance
  • Avoidance of software bloat
  • Minimize the effect of the Law of Unintended
    Consequences

7
Software Design
  • Fundamental concepts
  • Basic requirements
  • Task list
  • Methodology
  • Workflow assessment
  • Information and data flow
  • Task Organization
  • Software Organization

8
Fundamental Concepts for TGT Software
  • In designing image-guided therapeutic devices, we
    accept responsibility for the patients care.
  • The responsibility must be ours.
  • Mission critical engineering is evaluated not on
    its average performance but on its worst case
    performance.
  • Nobody dies in image space

TGT
9
Basic Requirements
  • Need images and knowledge of both the information
    they convey and their spatial characteristics.
  • Need a three (or six) dimensional tracking
    system.
  • Need a methodology for the visualization of path,
    structures and target.
  • Need a method of registration from physical space
    to image spaces
  • Correction for perioperative and intraoperative
    changes

TGT
10
Task List
  • Localizer
  • Display
  • Graphics
  • I/O
  • Registration
  • Correction

11
Methodology
  • Open Architecture with defined interfaces
  • DLL design for run time selection of function
  • Reduces software bloat
  • Allows rapid debug and leak detection
  • No communication between functions with different
    DLLs
  • Allows data encapsulization

12
Software Organization
13
New Software Design
Display
Localizer
IO
Video
Optotrak 3020
A-Mode US
Optotrak Certus
Tomogram
Polaris
LRS
Polaris Vicra
Rotational
Polhemus
Aurora
Biomechanical
2-D Images
Optical Biopsy
Claron
da Vinci
ORION
Graphic
Registration
Correction
Render
Deformation
Quaternion
Salient Feature
Biopsy
Functional
SVD
Patch
Preop Plan
HTM
ICP
Transparency
14
Applications of TGT
  • Intracranial Neurosurgery
  • Tumor resection
  • Implantation of Neuroprostheses
  • Functionally Guided Neurosurgery
  • Spinal Surgery
  • Liver Surgery
  • Colorectal Cancer Staging and Surgery
  • Ophthalmologic Surgery
  • Cochlear Implants

15
Applications of TGT
  • Kidney Surgery
  • Lung Therapy
  • Tumor resection/ablation/brachytherapy
  • Prostate Therapy
  • Open or robotic surgery
  • Brachytherapy
  • Direct injection Chemotherapy/ Gene Therapy

16
Image-Guided Neurosurgery
17
Image-Guided Liver Surgery (IGLS)
18
Spinal Surgery
Image
Guide
Confirm
19
Applications of TGT
Colorectal Cancer Staging and Surgery
  • One of the most prevalent cancers in the US
  • Visualization of the layered structure of the
    rectum is important for staging and therapy

20
Cochlear Implantation
  • Cochlear Implants

21
ORION Performance
  • System boot time in the OR 15 seconds
  • Number of image types Simultaneous display 4
  • Number of image types OR selectable 64
  • Image update (unsynched) 4 512x512 images at 63
    Hz.
  • Point based registration lt 10 ms
  • Surface based registration (liver, 20,000 points)
    35 seconds

22
Orion Code Base drives (1)
  • Intracranial Neurosurgery
  • Tumor resection
  • Implantation of Neuroprostheses
  • Functionally Guided Neurosurgery
  • Spinal Surgery
  • Liver Surgery
  • Direct injection Chemotherapy

23
Orion Code Base drives (2)
  • Colorectal Cancer Staging and Surgery
  • Ophthalmologic Surgery
  • Cochlear Implants
  • Robotic Image-Guided Surgery
  • Direct Injection Gene Therapy

24
Orion Licensing
  • Base program DLLs available for research
    license from Vanderbilt University
  • Custom DLL development is available by contract
    to Vanderbilt
  • ORION with FDA VV process available from
    Pathfinder Therapeutics Inc

25
Three important challenges for the engineering of
IGT systems
  • Validation
  • Agreed upon accuracy metrics
  • Phantom design
  • Human use
  • Robustness
  • Sensitivity to variability
  • Vertical Integration
  • Will the solution work for all patients

26
Help address these challenges
  • Image-Guidance is the modifier, not the driving
    force.
  • Involve the people doing the therapy at every
    step
  • Writing proposals
  • Reviewing proposals
  • Planning the protocols
  • Using the systems and providing feedback
  • IGS/IGT/IGP/TGT needs its own study section
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