CN102982238A - Three-dimensional kidney neoplasm surgery simulation method and platform based on computed tomography (CT) film - Google Patents
Three-dimensional kidney neoplasm surgery simulation method and platform based on computed tomography (CT) film Download PDFInfo
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Abstract
The invention discloses a three-dimensional kidney neoplasm surgery simulation method and a platform based on a computed tomography (CT) film. The method includes that firstly, a data base including object resources is built, multiple manners including CT film scanning are inputted into a CT faultage image, a sequence image is registered according to the sequence based on an outline gradient principle, a registered CT image is utilized to reconstruct segmentation tissue of an arterial phase, a venous phase and a lag phase by adopting of a three-dimensional reconstruction technology, and the segmentation tissue of the arterial phase, the venous phase and the lag phase are effectively fused in the same coordinate space. According to an imaging staging criteria and a treatment guideline of kidney neoplasm, and based on modeling results, various peration plan designing, operation stimulation, surgical risk analysis and response, and prognostic analysis are carried out, a personalized and benefit maximization treatment plan can be provided for an object, and skills and degree of proficiency of an operation can be improved, and the three-dimensional kidney neoplasm surgery simulation method can be used in medical teaching.
Description
Technical field
The invention belongs to Medical Image Processing and application, be specifically related to a kind of three-dimensional kidney neoplasms surgical simulation method and platform thereof based on the CT film.The present invention can take full advantage of and contain the CT film scanning in interior multiple source CT view data, effectively realize medical image segmentation and the three-dimensional modeling of artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney, intuitively, the stereo display virtual environment, and gathered the design of kidney neoplasms multiple analog operation plan, surgical simulation, operation risk analysis and reply, prognostic analysis.
Background technology
The M ﹠ M of kidney neoplasms accounts in general tumour about 2%, and Urology Surgery malignant tumour carcinoma mesonephric accounts for second in China.The base therapy of kidney is radical nephrectomy, the incidence of offside kidney chronic kidney disease increases after the radical nephrectomy, the relation that itself and cardiovascular disease incidence rate, mortality ratio are proportionate, and popularizing and the development of Imaging Technology along with health check-up, the recall rate of asymptomatic kidney case obviously increases, the mode for the treatment of kidney no longer is confined to radical nephrectomy, is diversified trend: such as widespread use and the development of the partial nephrectomy that keeps the nephron, the radio-frequency ablation procedure for the treatment of kidney, cryoablation etc. and laparoscopic renal oncotherapy technology.The theory of " precisely surgery " is promoting the development of modern surgery technology, and three-dimensional visualization technique and the virtual reality technology range of application in medical science is also day by day wide.Utilize the CT view data to carry out three-dimensional reconstruction, construct the anatomical structure three-dimensional model of human organ, can allow tumour, the region of interest such as important blood vessels show with three dimensional form " truly ", three-dimensionally observe and measure each anatomical structure from all angles, determine exactly the locus of tumour, size, geometric configuration and with the spatial relationship of structures surrounding, and can be on three-dimensional model, utilize virtual reality technology to carry out the preplanning of Extraordinary art and sham operated, make the front assessment of art of operation feasibility more accurate, prepare more abundant before the art, the formulation of operation plan has personalization, and is more objective, rationally.
At the kidney surgical field, domestic Li Cheng etc. utilize Medical Image Three Dimensional Visualization System to reconstruct confession based on 16 row's Spiral CT scan data in clinical living renal transplantation, three-dimensional model (the Li Cheng of acceptor, Fang Chihua, Li Xiaofeng, Deng. the simulation study of living renal transplantation digital visual. Nanfang Medical Univ's journal, 2011,31:983-986), living renal transplantation after rebuilding is supplied to be subjected to body three-dimensional models to import to FreeForm Modeling System, according to each case characteristic, make the most rational individual operation scheme, kidney and the vascular pattern thereof of reconstruction are clear, stereoscopic sensation is strong, can recognize kidney blood vessel and blood vessel variation situation three-dimensionally, according to these case characteristics, rational the individual operation scheme, optimized the modus operandi of living renal transplantation, improve success rate of operation, reduced operation risk.
External multidigit scholar utilizes the CT scan data reconstruction to go out the three-dimensional model of renal blood vessels, kidney and tumour, utilize visual vascular pattern to carry out assessing, draw up a plan for, improve modus operandi (referring to one: Wunderlich H before the art, Reichelt O, Schubert R, Zermann DH, Schubert J. Preoperative simulation of partial nephrectomy with three-dimensional computed tomography. BJU Int. 2000 Nov; 86 (7): 777-81. is referring to two: Knudsen BE, Campbell G, Kennedy A, et al. Design of functional simulation of renal cancer in virtual reality environments. Urology. 2005 Oct; 66 (4): 732-5. is referring to three: Marukawa K, Horiguchi J, Shigeta M, et al. Laparoscopic nephron-sparing surgery:preoperative assessment with three-dimensional computed tomography. Eur Urol. 2005 Jan; 47 (1): 92-7. 4. Ukimura O, Nakamoto M, Gill IS. Three-dimensional reconstruction of renovascular-tumor anatomy to facilitate zero-ischemia partial nephrectomy. Eur Urol. 2012 Jan; 61 (1): 211-7.).
The visual operation planning systems of application (Virtual Surgical Planning) such as Lasser MS of U.S. Albert einstein medical college in 2012 carry out three-dimensional reconstruction, surgery planning and sham operated (the Lasser MS of kidney, renal blood vessels, renal plevis kidney calices and tumour, Doscher M, Keehn A, et al. Virtual surgical planning:a novel aid to robot-assisted laparoscopic partial nephrectomy. J Endourol. 2012 Oct; 26 (10): 1372-9.), and be applied to virtual robot assisted laparoscope partial nephrectomy, the relation of the size of energy Measurement accuracy tumour, anatomical structure, tumour and the blood vessel of vessel branch, set flow guiding structure, tumour is in the complexity of invading the profit degree of depth, assessment tumor resection of nephrolithotomy, and utilize interactive mode to simulate tumor resection, cook up suitable surgical intervention scheme.
Just at the early-stage abroad in Urological Field virtual operation simulation system or analogue system, the domestic report that there is not yet.Moreover, actual state in view of China, when examining, the patient of outer court often only carries the CT film that do institutes outside, and can't or be difficult for obtaining the iconography data of digital format, be subject in addition the not enough or disappearance that three-dimensional information intuitively presents in the existing CT sheet, the restriction of the factors such as otherness of image doctor and clinician's focus, be generally address this problem and have to carry out enhanced CT reexamine, brought the waste of medical resource, increased the anaphylactoid probability of patient, the radiant quantity of x-ray and economic burden, how to take full advantage of this part patient's existing resource, avoid rechecking, meet just the fundamental policy of China's medical reform.
Present only research is only for some aspect, it mainly is the kidney neoplasms resection, carry out the front analysis of art, surgery planning simulation, for common multiple kidney neoplasms treatment means, such as surgery planning and the modeling effort shorter mention of radical nephrectomy, laparoscopic surgery, radio-frequency ablation procedure, cryoablation, lack effective method and platform comprehensive simulation operation plan and risk, prognosis are carried out analysis-by-synthesis.
Summary of the invention
The purpose of this invention is to provide a kind of three-dimensional kidney neoplasms surgical simulation method and platform thereof based on the CT film, the present invention can effectively utilize and contain the CT film scanning at interior multiple CT image resource, effectively realize medical image segmentation and the three-dimensional modeling of artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney, and combine the design of kidney neoplasms multiple analog operation plan, surgical simulation, operation risk analysis and reply, prognostic analysis.
A kind of three-dimensional kidney neoplasms surgical simulation method based on the CT film provided by the invention, its step comprises:
(1) building database: database comprises the essential information of storing object, comprise name, sex, age, medical history, complication, biochemical analysis information, the CT image library provides the kidney neoplasms operation plan planning needed feature of simulation and information, is used for operation plan design and venture analysis;
CT faultage image input mode in the described CT image comprises CT film scanning, network interface card, CD etc., and wherein the film scanning image needs to scan the skew that causes by positive parallel projection check and correction, carries out the cutting of image again;
The cutting of described image be in the single width tomography CT image around the outermost edge of Word message delimit rectangle frame as benchmark, its sanction is divided into is image sequence, that contain single width tomography CT content; With the actual representative length of scale in the first width of cloth image difference divided by scale two-end-point pixel coordinate, obtain the unit picture element size, the pixel size of remaining image and this width of cloth image being divided by obtains scaling again, thereby take first width of cloth image as benchmark, further corrects after sequence image cut out minute;
(2) image registration: from database, extract the CT image of object, sequence image is carried out according to the order of sequence registration based on profile gradual change principle;
(3) three-dimensional modeling: utilize the CT image behind the registration, set up kidney, kidney neoplasms, the arteria renalis, renal vein, kidney calices renal plevis, ureteral three-dimensional model, its process is:
(3.1) cut apart artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney: the separation calculation method that adopts the dynamic self-adapting region growing, the gray threshold of Offered target organ, homogeneity degree according to the target organ gray-scale value is adjusted, then select a Seed Points as initial point at area-of-interest, be partitioned into target area image, namely be partitioned into for the related tissue of sham operated conceptual design, sham operated and venture analysis, comprise artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney;
(3.2) set up kidney, kidney neoplasms, the arteria renalis, renal vein, kidney calices renal plevis, ureteral three-dimensional model: adopt three-dimensional reconstruction to rebuild the tissue that arterial phase, venous phase, period of delay are cut apart mutually, and in same coordinate space effective integration;
(4) operation plan design, sham operated, operation risk is analyzed and reply, prognostic analysis: according to image standard and the practice guidelines by stages of kidney neoplasms, the resulting modeling result of data in the integrated data base and step (3), calculate kidney by computing machine, kidney neoplasms, the various correlation parameters of blood vessel and set flow guiding structure, comprise the kidney neoplasms diameter, volume, number, with distance of on every side important blood vessels and tissue etc., object-based kidney three-dimensional model carries out the operation plan design, sham operated, simulation planning operation pathway, and the result of board design carried out operation risk analysis and reply and prognostic analysis, can be object Extraordinary is provided, benefited maximized therapeutic scheme; By surgical simulation repeatedly, can improve user's surgical skills and proficiency, and can also be used for medical teaching.Its process is as follows:
(4.1) operation plan design:
When carrying out radical nephrectomy, partial nephrectomy, radio-frequency ablation procedure, cryoablation and laparoscopic surgery conceptual design, undertaken by following process respectively:
A radical nephrectomy: according to the kidney model of rebuilding, position, the tumour of analyzing tumour have or not invades the profit surrounding tissue, have or not the existence of accessory renal artery, the anatomical variation that renal artery branch, dark vein belong to or because the extruding of tumour is subjected to displacement, have or not cancer embolus in the renal vein, unusual tumor vessels etc. are analyzed feasibility and the security of radical nephrectomy, and can judge the compensatory situation of offside kidney postoperative function according to the data in the data bank;
B partial nephrectomy: according to blood vessel and kidney neoplasms relation, the situation of getting involved of kidney, position, size and the related kidney segment information of kidney neoplasms in the kidney of the kidney model demonstration of rebuilding, kidney neoplasms is carried out the resectability analysis, determine the safety zone of kidney neoplasms excision by the mode that the kidney neoplasms edge of model is outwards expanded, and can mark by the vessel branch of this regional effect and set flow guiding structure at three-dimensional model, this part is sewed up as risk zones and simulation.Carry out simultaneously the operation plan planning of irregular partial nephrectomy based on the deformation curved surface of tumour, kidney section, set flow guiding structure.In addition art middle kidney artery occlusion mode is carried out feasibility analysis, as: main renal artery blocking-up, renal artery branch blocking-up, segmental renal artery blocking-up, three grades of branch's blocking-up of the arteria renalis, tumour artery occlusion etc., mark is set out the arteries and veins feed region on three-dimensional model, calculates the ratio that hot ischemic volume accounts for total kidney volume;
C radio-frequency ablation procedure: the possibility that supplies the situation analysis RF ablation according to kidney neoplasms position, size, blood, and the size and shape of planning radio-frequency ablation electrode, pass through the operative approach of the mode circle electrode of simulation at the kidney three-dimensional model of object, calculate ablation range, and analyze the possibility that melts rear kidney local hemorrhage, urinary fistula;
D cryoablation: the possibility that supplies the situation analysis cryoablation according to kidney neoplasms position, size, blood, and the size and shape of planning cryoprobe, on the kidney three-dimensional model of object, define the operative approach of cryoprobe by the mode of simulation, calculate ablation range, and analyze the possibility that melts rear kidney local hemorrhage, urinary fistula;
The E laparoscopic surgery: the rotation by the kidney three-dimensional model, translation, amplifying observation are observed the relation of tumour and blood vessel, kidney calices renal plevis from different perspectives with the orientation, separation, cutting route and RF ablation, the Puncture approach of cryoablation, the degree of depth, the ablation range of simulation laparoscopic surgery are analyzed feasibility and the security of above A, B, C, D operation employing laparoscopic surgery;
(4.2) sham operated:
Adopt the first visual angle technology, utilize the virtual operation instrument to carry out surgical simulation, and by adding the force feedback hardware device, the touch feeling in the sham operated process, the authenticity of increase analog simulation;
As the first visual angle exploitation operative approach, truly reflect operative status with the user, utilize graphic process unit to carry out the data efficient real-time rendering;
The kidney modeling that contacts by the virtual operation instrument that operates on computers this platform and provide carries out radical nephrectomy, partial nephrectomy, radio-frequency ablation procedure, cryoablation and laparoscopic surgery simulation process, the mode that adopts has the approach of sham operated, separate, cutting route and RF ablation, the Puncture approach of cryoablation and the degree of depth, the vital tissue structure that caution runs into and the rational disposal route of planning, the size that shows otch, the color of visual otch inside, transparency or rotation, translation, the scope that scalable manner is observed the tangent plane situation or melted with the orientation from different perspectives;
In simulation process, make up the deformation process of realistic simulation soft tissue in surgical procedure, and use the force feedback hardware device to carry out the touch feeling model building of surgical simulation process, make the user separate the kidney three-dimensional model, produce continuous touch feeling when cutting, touch, crawl, sew application, for the user provides feeling of immersion true to nature.By the repeatedly simulation of various surgical technics, can also improve user's surgical skills and skill level, and can also be used for medical teaching;
(4.3) operation risk analysis and reply and prognostic analysis
The result of the data in the integrated data base and operation plan design, sham operated carries out operation risk analysis and reply and prognostic analysis.
The present invention also provides a kind of platform of realizing above-mentioned three-dimensional kidney neoplasms surgical simulation method based on the CT film, and this platform comprises Database module, database module, image registration module, three-dimensional modeling module, operation plan design module, sham operated module, operation risk analysis and reply module, prognostic analysis module and device for force feedback;
The Database module is used for by being written into the object essential information, the biochemical analysis data, and the CT image library is set up the corresponding object data, obtains database module; This database provides the kidney neoplasms operation plan planning needed feature of simulation and information, is used for operation plan design, operation risk analysis and reply, prognostic analysis, finishes the function of above-mentioned steps (1);
The image registration module is extracted the CT image of object from database module, sequence image is carried out according to the order of sequence registration based on profile gradual change principle, finishes the function of above-mentioned steps (2);
The three-dimensional modeling module realizes the three-dimensional modeling of kidney, kidney neoplasms, blood vessel structure, set flow guiding structure, for follow-up operation plan design module provides the three-dimensional model of object, finishes the function of above-mentioned steps (3);
The three-dimensional model that the operation plan design module is set up the three-dimensional modeling module calculates the various correlation parameters of kidney, kidney neoplasms, blood vessel and set flow guiding structure by computing machine, comprise kidney neoplasms diameter, volume, number, with the distance of on every side important blood vessels and tissue etc., carry out the operation plan design; The sham operated module is carried out the simulation of various operation plans according to the operation designing scheme of operation plan design module, adds device for force feedback in simulation process, increases the authenticity of surgical simulation; Operation risk is analyzed and the reply module is analyzed operation risk to the various sham operated schemes of sham operated module in conjunction with the Information integration in the database module, takes counter-measure; The prognostic analysis module is predicted the curative effect of the different sham operated schemes in the sham operated module, analyzes possible prognosis, finishes the function of above-mentioned steps (4).
Image registration module among the present invention comprises the data importing module of registration, the registration module that is connected with the data importing module of registration; The data importing module of registration is extracted the CT image of object from database module, be transferred to registration module, and sequence image is carried out according to the order of sequence registration based on profile gradual change principle.
Three-dimensional modeling module among the present invention comprises that registering images imports module, cuts apart module, three-dimensional reconstruction module, Fusion Module; Registering images imports the image transmitting of module after with the registration module registration to cutting apart module, carry out being transferred to the three-dimensional reconstruction module behind the image segmentation, further being organized in of rebuilding mutually arterial phase, venous phase, period of delay carried out effective integration in same coordinate space in the Fusion Module, set up the three-dimensional model of artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney.
Operation plan design module among the present invention comprises conceptual design data importing module and conceptual design module; Conceptual design data importing module is connected with the three-dimensional modeling module, import kidney, kidney neoplasms, the arteria renalis, renal vein, kidney calices renal plevis, ureteral three-dimensional model and calculate the various correlation parameters of kidney, kidney neoplasms, blood vessel and set flow guiding structure by computing machine, comprise kidney neoplasms diameter, volume, number, with the distance of on every side important blood vessels and tissue etc.; The conceptual design module is carried out the operation plan design according to the result of conceptual design data importing module;
Sham operated module among the present invention is connected with the operation plan design module, carries out the simulation of various operation plans according to the operation designing scheme;
Operation risk analysis among the present invention and reply module are connected with the sham operated module, and various sham operated schemes are analyzed operation risk and counter-measure in conjunction with the Information integration in the database module;
Prognostic analysis module among the present invention is connected with the sham operated module, and the curative effect of different sham operated schemes is predicted, analyzes possible prognosis;
Device for force feedback among the present invention is connected with the sham operated module, adds force feedback in simulation process, increases the authenticity of surgical simulation.
The present invention compared with prior art has following beneficial effect: 1. the present invention takes full advantage of existing CT film resource in patient's hand, effectively avoided rechecking, reduced the waste of medical resource, the anaphylactoid probability of patient, the radiant quantity of x-ray and the burden of economy have been reduced, meet the existing national conditions of China, the fundamental policy that meets China's medical reform, the problem of solution Expensive and hard to visit doctors; 2. the present invention has realized medical image segmentation and the three-dimensional modeling of artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney effectively, intuitively, the stereo display virtual environment, and gathered the design of kidney neoplasms multiple analog operation plan, surgical simulation, operation risk analysis and reply, prognostic analysis; Can be object Extraordinary, benefited maximized therapeutic scheme are provided; Adopt the first visual angle technology, utilize the virtual operation instrument to carry out surgical simulation, and by adding the force feedback hardware device, touch feeling in the sham operated process, increase the authenticity of analog simulation, by surgical simulation repeatedly, can improve user's surgical skills and proficiency, and can also be used for medical teaching.
Description of drawings
Fig. 1 is the schematic flow sheet that the present invention is based on the three-dimensional kidney neoplasms surgical simulation method of CT film;
Fig. 2 is the structural representation that the present invention is based on the three-dimensional kidney neoplasms surgical simulation platform of CT film.
Embodiment
The below is described in further detail technical scheme of the present invention:
As shown in Figure 1, the present invention includes following steps:
(1) building database: database comprises the essential information of storing object, comprise name, sex, age, medical history, complication, biochemical analysis information, the CT image library provides the kidney neoplasms operation plan planning needed feature of simulation and information, is used for operation plan design and venture analysis.
CT faultage image input mode in the described CT image comprises CT film scanning, network interface card, CD etc., and wherein the film scanning image needs to scan the skew that causes by positive parallel projection check and correction, carries out the cutting of image again.
The cutting of described image be in the single width tomography CT image around the outermost edge of Word message delimit rectangle frame as benchmark, its sanction is divided into is image sequence, that contain single width tomography CT content; With the actual representative length of scale in the first width of cloth image difference divided by scale two-end-point pixel coordinate, obtain the unit picture element size, the pixel size of remaining image and this width of cloth image being divided by obtains scaling again, thereby take first width of cloth image as benchmark, further corrects after sequence image cut out minute.
Described database can adopt the platforms such as Oracle, MySQL, SQL Server2000/2005 to set up.
(2) image registration: from database, extract the CT image of object, sequence image is carried out according to the order of sequence registration based on profile gradual change principle.
(3) three-dimensional modeling: utilize the CT image behind the registration, set up kidney, kidney neoplasms, the arteria renalis, renal vein, kidney calices renal plevis, ureteral three-dimensional model, its process is:
(3.1) cut apart artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney: the separation calculation method that adopts the dynamic self-adapting region growing, the gray threshold of Offered target organ, homogeneity degree according to the target organ gray-scale value is adjusted, then select a Seed Points as initial point at area-of-interest, be partitioned into target area image, namely be partitioned into for the related tissue of sham operated conceptual design, sham operated and venture analysis, comprise artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney.
(3.2) set up kidney, kidney neoplasms, the arteria renalis, renal vein, kidney calices renal plevis, ureteral three-dimensional model: adopt three-dimensional reconstruction, utilize VTK(Visualization Toolkit) or OSG(Open Scene Graph) etc. reconstruct (3.1) and process the data obtain, the tissue that shows that arterial phase, venous phase, period of delay are cut apart mutually directly perceived, and in same coordinate space effective integration.
(4) operation plan design, sham operated, operation risk is analyzed and reply, prognostic analysis: according to image standard and the practice guidelines by stages of kidney neoplasms, the resulting modeling result of data in the integrated data base and step (3), calculate kidney by computing machine, kidney neoplasms, the various correlation parameters of blood vessel and set flow guiding structure, comprise the kidney neoplasms diameter, volume, number, with distance of on every side important blood vessels and tissue etc., object-based kidney three-dimensional model carries out the operation plan design, sham operated, simulation planning operation pathway, and the result of board design carried out operation risk analysis and reply and prognostic analysis, can be object Extraordinary is provided, benefited maximized therapeutic scheme; By surgical simulation repeatedly, can improve user's surgical skills and proficiency, and can also be used for medical teaching.Its process is as follows:
(4.1) operation plan design:
When carrying out radical nephrectomy, partial nephrectomy, radio-frequency ablation procedure, cryoablation and laparoscopic surgery conceptual design, undertaken by following process respectively:
A radical nephrectomy: according to the kidney model of rebuilding, position, the tumour of analyzing tumour have or not invades the profit surrounding tissue, have or not the existence of accessory renal artery, the anatomical variation that renal artery branch, dark vein belong to or because the extruding of tumour is subjected to displacement, have or not cancer embolus in the renal vein, unusual tumor vessels etc. are analyzed feasibility and the security of radical nephrectomy, and can judge the compensatory situation of offside kidney postoperative function according to the data in the data bank;
B partial nephrectomy: according to blood vessel and kidney neoplasms relation, the situation of getting involved of kidney, position, size and the related kidney segment information of kidney neoplasms in the kidney of the kidney model demonstration of rebuilding, kidney neoplasms is carried out the resectability analysis, determine the safety zone of kidney neoplasms excision by the mode that the kidney neoplasms edge of model is outwards expanded, and can mark by the vessel branch of this regional effect and set flow guiding structure at three-dimensional model, this part is sewed up as risk zones and simulation.Carry out simultaneously the operation plan planning of irregular partial nephrectomy based on the deformation curved surface of tumour, kidney section, set flow guiding structure.In addition art middle kidney artery occlusion mode is carried out feasibility analysis, as: main renal artery blocking-up, renal artery branch blocking-up, segmental renal artery blocking-up, three grades of branch's blocking-up of the arteria renalis, tumour artery occlusion etc., mark is set out the arteries and veins feed region on three-dimensional model, calculates the ratio that hot ischemic volume accounts for total kidney volume;
C radio-frequency ablation procedure: supply the possibility of situation analysis RF ablation according to kidney neoplasms position, size, blood, and plan the size and shape of radio-frequency ablation electrode
Calculate ablation range, and analyze the possibility that melts rear kidney local hemorrhage, urinary fistula;
D cryoablation: the possibility that supplies the situation analysis cryoablation according to kidney neoplasms position, size, blood, and the size and shape of planning cryoprobe, on the kidney three-dimensional model of object, define the operative approach of cryoprobe by the mode of simulation, calculate ablation range, and analyze the possibility that melts rear kidney local hemorrhage, urinary fistula;
The E laparoscopic surgery: the rotation by the kidney three-dimensional model, translation, amplifying observation are observed the relation of tumour and blood vessel, kidney calices renal plevis from different perspectives with the orientation, separation, cutting route and RF ablation, the Puncture approach of cryoablation, the degree of depth, the ablation range of simulation laparoscopic surgery are analyzed feasibility and the security of above A, B, C, D operation employing laparoscopic surgery;
(4.2) sham operated:
Adopt the first visual angle technology, utilize the virtual operation instrument to carry out surgical simulation, and by adding the force feedback hardware device, the touch feeling in the sham operated process, the authenticity of increase analog simulation;
As the first visual angle exploitation operative approach, truly reflect operative status with the user, utilize graphic process unit to carry out the data efficient real-time rendering;
The kidney modeling that contacts by the virtual operation instrument that operates on computers this platform and provide carries out radical nephrectomy, partial nephrectomy, radio-frequency ablation procedure, cryoablation and laparoscopic surgery simulation process, the mode that adopts has the approach of sham operated, separate, cutting route and RF ablation, the Puncture approach of cryoablation and the degree of depth, the vital tissue structure that caution runs into and the rational disposal route of planning, the size that shows otch, the color of visual otch inside, transparency or rotation, translation, the scope that scalable manner is observed the tangent plane situation or melted with the orientation from different perspectives;
In simulation process, make up the deformation process of realistic simulation soft tissue in surgical procedure, and use the force feedback hardware device to carry out the touch feeling model building of surgical simulation process, make the user separate the kidney three-dimensional model, produce continuous touch feeling when cutting, touch, crawl, sew application, for the user provides feeling of immersion true to nature.By the repeatedly simulation of various surgical technics, can also improve user's surgical skills and skill level, and can also be used for medical teaching;
(4.3) operation risk analysis and reply and prognostic analysis
The result of the data in the integrated data base and operation plan design, sham operated carries out operation risk analysis and reply and prognostic analysis.
The present invention also provides a kind of platform of realizing above-mentioned three-dimensional kidney neoplasms surgical simulation method based on the CT film, as shown in Figure 2, this platform comprises Database module 1, database module 2, image registration module 3, three-dimensional modeling module 4, operation plan design module 5, sham operated module 6, operation risk analysis and reply module 7, prognostic analysis module 8 and device for force feedback 9;
Database module 1 is used for by being written into the object essential information, the biochemical analysis data, and the CT image library is set up the corresponding object data, obtains database module 2; This database provides the kidney neoplasms operation plan planning needed feature of simulation and information, be used for operation plan design, operation risk analysis and reply, prognostic analysis, database can adopt the platforms such as Oracle, MySQL, SQL Server2000/2005 to set up, and finishes the function of above-mentioned steps (1);
Image registration module 3 is extracted the CT image of object from database module 2, sequence image is carried out according to the order of sequence registration based on profile gradual change principle, this image registration module 3 comprises the data importing module 31 of registration, the registration module 32 that is connected with the data importing module 31 of registration; The data importing module 31 of registration is extracted the CT image of object from database module 2, be transferred to registration module 32, and sequence image is carried out according to the order of sequence registration based on profile gradual change principle, finishes the function of above-mentioned steps (2);
Three-dimensional modeling module 4 realizes the three-dimensional modeling of kidney, kidney neoplasms, blood vessel structure, set flow guiding structure, and the three-dimensional model of object is provided for follow-up operation plan design module 5.This three-dimensional modeling module 4 comprises that registering images imports module 41, cuts apart module 42, three-dimensional reconstruction module 43, Fusion Module 44; Registering images imports the image transmitting of module 41 after with registration module 32 registrations to cutting apart module 42, carry out being transferred to three-dimensional reconstruction module 43 behind the image segmentation, further being organized in of rebuilding mutually arterial phase, venous phase, period of delay carried out effective integration in same coordinate space in the Fusion Module 44, set up the three-dimensional model of artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney, finish the function of above-mentioned steps (3);
Operation plan design module 5 comprises conceptual design data importing module 51 and conceptual design module 52; Conceptual design data importing module 51 is connected with three-dimensional modeling module 4, import kidney, kidney neoplasms, the arteria renalis, renal vein, the kidney calices renal plevis, ureteral three-dimensional model and calculate kidney by computing machine, kidney neoplasms, the various correlation parameters of blood vessel and set flow guiding structure, comprise the kidney neoplasms diameter, volume, number, with distance of on every side important blood vessels and tissue etc., can be object Extraordinary is provided, benefited maximized therapeutic scheme, select radical nephrectomy, partial nephrectomy, radio-frequency ablation procedure, cryoablation and laparoscopic surgery simulation, undertaken by following module respectively: A radical nephrectomy module: according to the kidney model of rebuilding, analyze the position of tumour, tumour has or not invades the profit surrounding tissue, have or not the existence of accessory renal artery, renal artery branch, the anatomical variation that dark vein belongs to or because the extruding of tumour is subjected to displacement, have or not cancer embolus in the renal vein, unusual tumor vessel etc., and can judge the compensatory situation of offside kidney postoperative function according to the data in the data bank.B partial nephrectomy module: according to blood vessel and kidney neoplasms relation, the situation of getting involved of kidney, position, size and the related kidney segment information of kidney neoplasms in the kidney of the kidney model demonstration of rebuilding, kidney neoplasms is carried out the resectability analysis, determine the safety zone of kidney neoplasms excision by the mode that the kidney neoplasms edge of model is outwards expanded, and can mark by the vessel branch of this regional effect and set flow guiding structure at three-dimensional model, this part is sewed up as risk zones and simulation.Carry out simultaneously the operation plan planning of irregular partial nephrectomy based on the deformation curved surface of tumour, kidney section, set flow guiding structure.In addition art middle kidney artery occlusion mode is carried out feasibility analysis, as: main renal artery blocking-up, renal artery branch blocking-up, segmental renal artery blocking-up, three grades of branch's blocking-up of the arteria renalis, tumour artery occlusion etc., mark is set out the arteries and veins feed region on three-dimensional model, calculates the ratio that hot ischemic volume accounts for total kidney volume.C radio-frequency ablation procedure module: the possibility that supplies the situation analysis RF ablation according to kidney neoplasms position, size, blood, and the size and shape of planning radio-frequency ablation electrode, on the kidney three-dimensional model of object, define the operative approach of electrode by the mode of simulation, calculate ablation range, and analyze the possibility that melts rear kidney local hemorrhage, urinary fistula.D cryoablation module: the possibility that supplies the situation analysis cryoablation according to kidney neoplasms position, size, blood, and the size and shape of planning cryoprobe, on the kidney three-dimensional model of object, define the operative approach of cryoprobe by the mode of simulation, calculate ablation range, and analyze the possibility that melts rear kidney local hemorrhage, urinary fistula.E laparoscopic surgery module: above A, B, C, D operation all can be used laparoscopic technique, more can embody the characteristic of minimally invasive surgery.Laparoscopically visual area can only show two dimensional image, lack distance perspective and depth perception, hemostasis, stitching be difficulty comparatively, rotation, translation, amplifying observation by three-dimensional model observed tumour and blood vessel with the orientation from different perspectives, gathered the relation of flow guiding structure, determines separation, cutting route and the RF ablation of sham operated, Puncture approach and the degree of depth of cryoablation.Conceptual design module 52 is carried out the operation plan design according to the result of conceptual design data importing module 51.
Sham operated module 6 is connected with operation plan design module 5, sham operated module 6 is carried out the simulation of various operation plans according to the operation designing scheme of operation plan design module 5, in simulation process, add device for force feedback 9, increase the authenticity of surgical simulation; Operation risk analysis and reply module 7 are connected with sham operated module 6, and the various sham operated schemes of operation risk analysis and 7 pairs of sham operated modules 6 of reply module are analyzed operation risk in conjunction with the Information integration in the database module 2, take counter-measure; Prognostic analysis module 8 is connected with sham operated module 6, and the curative effect of the different sham operated schemes in 8 pairs of sham operated modules 6 of prognostic analysis module is predicted, analyzes possible prognosis, finishes the function of above-mentioned steps (4).
Device for force feedback 9 is connected with sham operated module 6, adds force feedback in simulation process, increases the authenticity of surgical simulation.Device for force feedback 9 can adopt Sensable-commercially available prod such as PHANTOM series force feedback equipment.
Claims (5)
1. three-dimensional kidney neoplasms surgical simulation method based on the CT film, it is characterized in that: it may further comprise the steps:
(1) building database: database comprises the essential information of storing object, comprise name, sex, age, medical history, complication, biochemical analysis information, the CT image library provides the kidney neoplasms operation plan planning needed feature of simulation and information, is used for operation plan design and venture analysis;
CT faultage image input mode in the described CT image comprises CT film scanning, network interface card, CD etc., and wherein the film scanning image needs to scan the skew that causes by positive parallel projection check and correction, carries out the cutting of image again;
The cutting of described image be in the single width tomography CT image around the outermost edge of Word message delimit rectangle frame as benchmark, its sanction is divided into is image sequence, that contain single width tomography CT content; With the actual representative length of scale in the first width of cloth image difference divided by scale two-end-point pixel coordinate, obtain the unit picture element size, the pixel size of remaining image and this width of cloth image being divided by obtains scaling again, thereby take first width of cloth image as benchmark, further corrects after sequence image cut out minute;
(2) image registration: from database, extract the CT image of object, sequence image is carried out according to the order of sequence registration based on profile gradual change principle;
(3) three-dimensional modeling: utilize the CT image behind the registration, set up kidney, kidney neoplasms, the arteria renalis, renal vein, kidney calices renal plevis, ureteral three-dimensional model, its process is:
(3.1) cut apart artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney: the separation calculation method that adopts the dynamic self-adapting region growing, the gray threshold of Offered target organ, homogeneity degree according to the target organ gray-scale value is adjusted, then select a Seed Points as initial point at area-of-interest, be partitioned into target area image, namely be partitioned into for the related tissue of sham operated conceptual design, sham operated and venture analysis, comprise artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney;
(3.2) set up kidney, kidney neoplasms, the arteria renalis, renal vein, kidney calices renal plevis, ureteral three-dimensional model: adopt three-dimensional reconstruction to rebuild the tissue that arterial phase, venous phase, period of delay are cut apart mutually, and in same coordinate space effective integration;
(4) operation plan design, sham operated, operation risk is analyzed and reply, prognostic analysis: according to image standard and the practice guidelines by stages of kidney neoplasms, the resulting modeling result of data in the integrated data base and step (3), calculate kidney by computing machine, kidney neoplasms, the various correlation parameters of blood vessel and set flow guiding structure, comprise the kidney neoplasms diameter, volume, number, with distance of on every side important blood vessels and tissue etc., object-based kidney three-dimensional model carries out the operation plan design, sham operated, simulation planning operation pathway, and the result of board design carried out operation risk analysis and reply and prognostic analysis, can be object Extraordinary is provided, benefited maximized therapeutic scheme; By surgical simulation repeatedly, user's surgical skills and proficiency can be improved, and medical teaching can also be used for, its process is as follows:
(4.1) operation plan design:
When carrying out radical nephrectomy, partial nephrectomy, radio-frequency ablation procedure, cryoablation and laparoscopic surgery conceptual design, undertaken by following process respectively:
A radical nephrectomy: according to the kidney model of rebuilding, position, the tumour of analyzing tumour have or not invades the profit surrounding tissue, have or not the existence of accessory renal artery, the anatomical variation that renal artery branch, dark vein belong to or because the extruding of tumour is subjected to displacement, have or not cancer embolus in the renal vein, unusual tumor vessels etc. are analyzed feasibility and the security of radical nephrectomy, and can judge the compensatory situation of offside kidney postoperative function according to the data in the data bank;
B partial nephrectomy: according to blood vessel and kidney neoplasms relation in the kidney of the kidney model demonstration of rebuilding, the situation of getting involved of kidney, the position of kidney neoplasms, big or small and related kidney segment information, kidney neoplasms is carried out the resectability analysis, determine the safety zone of kidney neoplasms excision by the mode that the kidney neoplasms edge of model is outwards expanded, and can mark by the vessel branch of this regional effect and set flow guiding structure at three-dimensional model, this part is sewed up as risk zones and simulation, simultaneously based on tumour, the kidney section, the deformation curved surface of set flow guiding structure carries out the operation plan planning of irregular partial nephrectomy, in addition art middle kidney artery occlusion mode is carried out feasibility analysis, as: the main renal artery blocking-up, the renal artery branch blocking-up, the segmental renal artery blocking-up, three grades of branch's blocking-up of the arteria renalis, tumour artery occlusion etc., mark is set out the arteries and veins feed region on three-dimensional model, calculates the ratio that hot ischemic volume accounts for total kidney volume;
C radio-frequency ablation procedure: the possibility that supplies the situation analysis RF ablation according to kidney neoplasms position, size, blood, and the size and shape of planning radio-frequency ablation electrode, on the kidney three-dimensional model of object, define the operative approach of electrode by the mode of simulation, calculate ablation range, and analyze the possibility that melts rear kidney local hemorrhage, urinary fistula;
D cryoablation: the possibility that supplies the situation analysis cryoablation according to kidney neoplasms position, size, blood, and the size and shape of planning cryoprobe, on the kidney three-dimensional model of object, define the operative approach of cryoprobe by the mode of simulation, calculate ablation range, and analyze the possibility that melts rear kidney local hemorrhage, urinary fistula;
The E laparoscopic surgery: the rotation by the kidney three-dimensional model, translation, amplifying observation are observed the relation of tumour and blood vessel, kidney calices renal plevis from different perspectives with the orientation, separation, cutting route and RF ablation, the Puncture approach of cryoablation, the degree of depth, the ablation range of simulation laparoscopic surgery are analyzed feasibility and the security of above A, B, C, D operation employing laparoscopic surgery;
(4.2) sham operated:
Adopt the first visual angle technology, utilize the virtual operation instrument to carry out surgical simulation, and by adding the force feedback hardware device, the touch feeling in the sham operated process, the authenticity of increase analog simulation;
As the first visual angle exploitation operative approach, truly reflect operative status with the user, utilize graphic process unit to carry out the data efficient real-time rendering;
The kidney modeling that contacts by the virtual operation instrument that operates on computers this platform and provide carries out radical nephrectomy, partial nephrectomy, radio-frequency ablation procedure, cryoablation and laparoscopic surgery simulation process, the mode that adopts has the approach of sham operated, separate, cutting route and RF ablation, the Puncture approach of cryoablation and the degree of depth, the vital tissue structure that caution runs into and the rational disposal route of planning, the size that shows otch, the color of visual otch inside, transparency or rotation, translation, the scope that scalable manner is observed the tangent plane situation or melted with the orientation from different perspectives;
In simulation process, make up the deformation process of realistic simulation soft tissue in surgical procedure, and use the force feedback hardware device to carry out the touch feeling model building of surgical simulation process, make the user separate the kidney three-dimensional model, produce continuous touch feeling when cutting, touch, crawl, sew application, for the user provides feeling of immersion true to nature.By the repeatedly simulation of various surgical technics, can also improve user's surgical skills and skill level, and can also be used for medical teaching;
(4.3) operation risk analysis and reply and prognostic analysis
The result of the data in the integrated data base and operation plan design, sham operated carries out operation risk analysis and reply and prognostic analysis.
2. platform of realizing a kind of three-dimensional kidney neoplasms surgical simulation method based on the CT film claimed in claim 1, it is characterized in that: this platform comprises Database module (1), database module (2), image registration module (3), three-dimensional modeling module (4), operation plan design module (5), sham operated module (6), operation risk analysis and reply module (7), prognostic analysis module (8) and device for force feedback (9);
Database module (1) is used for by being written into the object essential information, the biochemical analysis data, and the CT image library is set up the corresponding object data, obtains database module (2); This database provides the kidney neoplasms operation plan planning needed feature of simulation and information, is used for operation plan design, operation risk analysis and reply, prognostic analysis, finishes the function of above-mentioned steps (1);
Image registration module (3) is extracted the CT image of object from database module (2), sequence image is carried out according to the order of sequence registration based on profile gradual change principle, finishes the function of above-mentioned steps (2);
Three-dimensional modeling module (4) realizes the three-dimensional modeling of kidney, kidney neoplasms, blood vessel structure, set flow guiding structure, for follow-up operation plan design module (5) provides the three-dimensional model of object, finishes the function of above-mentioned steps (3);
The three-dimensional model that operation plan design module (5) is set up three-dimensional modeling module (4) calculates the various correlation parameters of kidney, kidney neoplasms, blood vessel and set flow guiding structure by computing machine, comprise kidney neoplasms diameter, volume, number, with the distance of on every side important blood vessels and tissue etc., carry out the operation plan design; Sham operated module (6) is carried out the simulation of various operation plans according to the operation designing scheme of operation plan design module (5), adds device for force feedback (9) in simulation process, increases the authenticity of surgical simulation; Operation risk is analyzed and reply module (7) is analyzed operation risk to the various sham operated schemes of sham operated module (6) in conjunction with the Information integration in the database module (2), takes counter-measure; Prognostic analysis module (8) is predicted the curative effect of the different sham operated schemes in the sham operated module (6), analyzes possible prognosis, finishes the function of above-mentioned steps (4).
3. a kind of three-dimensional kidney neoplasms surgical simulation platform based on the CT film according to claim 2 is characterized in that:
Image registration module (3) comprises the data importing module (31) of registration, the registration module (32) that is connected with the data importing module (31) of registration; The data importing module (31) of registration is extracted the CT image of object from database module (2), be transferred to registration module (32), and sequence image is carried out according to the order of sequence registration based on profile gradual change principle.
4. a kind of three-dimensional kidney neoplasms surgical simulation platform based on the CT film according to claim 2 is characterized in that:
Three-dimensional modeling module (4) comprises that registering images imports module (41), cuts apart module (42), three-dimensional reconstruction module (43), Fusion Module (44); Registering images imports the image transmitting of module (41) after with registration module (32) registration to cutting apart module (42), carry out being transferred to three-dimensional reconstruction module (43) behind the image segmentation, further being organized in the Fusion Module (44) of rebuilding mutually arterial phase, venous phase, period of delay carried out effective integration in same coordinate space, set up the three-dimensional model of artery, venous structures and the set flow guiding structure of kidney, kidney neoplasms, kidney.
5. a kind of three-dimensional kidney neoplasms surgical simulation platform based on the CT film according to claim 2 is characterized in that:
Operation plan design module (5) comprises conceptual design data importing module (51) and conceptual design module (52); Conceptual design data importing module (51) is connected with three-dimensional modeling module (4), import kidney, kidney neoplasms, the arteria renalis, renal vein, kidney calices renal plevis, ureteral three-dimensional model and calculate the various correlation parameters of kidney, kidney neoplasms, blood vessel and set flow guiding structure by computing machine, comprise kidney neoplasms diameter, volume, number, with the distance of on every side important blood vessels and tissue etc.; Conceptual design module (52) is carried out the operation plan design according to the result of conceptual design data importing module (51);
Sham operated module (6) is connected with operation plan design module (5), carries out the simulation of various operation plans according to the operation designing scheme;
Operation risk is analyzed and reply module (7) is connected with sham operated module (6), and various sham operated schemes are analyzed operation risk and counter-measure in conjunction with the Information integration in the database module (2);
Prognostic analysis module (8) is connected with sham operated module (6), and the curative effect of different sham operated schemes is predicted, analyzes possible prognosis;
Device for force feedback (9) is connected with sham operated module (6), adds force feedback in simulation process, increases the authenticity of surgical simulation.
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