CN109259806A - A method of the accurate aspiration biopsy of tumour for image guidance - Google Patents
A method of the accurate aspiration biopsy of tumour for image guidance Download PDFInfo
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- CN109259806A CN109259806A CN201710579908.6A CN201710579908A CN109259806A CN 109259806 A CN109259806 A CN 109259806A CN 201710579908 A CN201710579908 A CN 201710579908A CN 109259806 A CN109259806 A CN 109259806A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B10/0233—Pointed or sharp biopsy instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/101—Computer-aided simulation of surgical operations
- A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/107—Visualisation of planned trajectories or target regions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2055—Optical tracking systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2065—Tracking using image or pattern recognition
Abstract
The invention discloses one kind to guide the accurate needle biopsy method of tumour for image, to improve the success rate and the precisely preoperative judgement of cancer pathology result of Oncological Surgery aspiration biopsy operation.Specific steps include that the preoperative CT of patient rebuilds (1), target tumor image segmentation (2), and the heterogeneous four-dimensional thermal map of inside tumor rebuilds (3), and puncture path plans (4), and 3-D image is registrated (5), AR navigation (6) in art;Heterogeneous feature of the present invention for room and time internal in Tumor Growth, for existing tumor aspiration biopsy operation in take out fraction pathological tissues at random, this problem of complete tumors phenotype cannot be represented, it is analysed by Quantitative image credit, the new method that precisely aspiration biopsy is performed the operation before Tumor Resection has been excavated, has provided integrated subplan for Tumor Resection preplanning and operation plan customization etc..
Description
Technical field
The invention belongs to computer graphics and surgical medicine fields, and in particular to the tumour based on image guidance precisely punctures
The method of biopsy.
Background technique
The research of tumour personalized medicines enters bottleneck stage, needs to combine new Research Thinking and direction.Currently, molecule is cured
It learns and individualized treatment scheme mainly passes through genomics (Genomics) and protein science (Proteomics) is swollen to detect
Tumor individuation characteristic.The major limitation of such methods is: needing through aspiration biopsy mode extraction section tumor tissues conduct
Pathological examination sample, due to the heterogeneity of room and time internal in Tumor Growth, the fraction tissue taken out at random is not
The characteristic of complete tumors tissue can be represented.Therefore, there is an urgent need to excavate the new method that precisely aspiration biopsy is performed the operation before Tumor Resection, it is
Tumor Resection preplanning and operation plan customization etc. provide integrated subplan.
Conventional tumor aspiration biopsy operation, is to be taken by speculum forceps according to different neoplastic lesion situations, perform the operation and cut
It removes or the method for puncture needle absorption takes out a fritter tissues from the diseased region of patient, after doing certain pathology slicing treatment,
By the Morphology of micro- sem observation lesion cell and tissue, pathological diagnosis is made.During this, doctor needs logical
The position that tumour is determined in some visual aids operations, such as CT guiding puncture, ultrasound guided puncture, MRI guiding puncture are crossed, this
A little auxiliary operations are used to help doctor to judge the spatial position of tumour, the position of aspiration biopsy, the direction of puncture and depth, from
And the path of puncture is cooked up, biopsy needle guide is punctured, and the fraction tissue for extracting lesion carries out biopsy.But it is existing to draw
It leads and navigation equipment, is all integrally punctured just for tumour, guiding puncture image is also only limited to two-dimensional gray level image and draws
It leads, inside tumor feature and 3-dimensional image feature can not be presented.
Summary of the invention
The invention discloses one kind to guide the accurate needle biopsy method of tumour for image, punctures to improve Oncological Surgery
Success rate and cancer pathology the result precisely preoperative judgement of biopsy procedure.
Specific steps include the preoperative image reconstruction of patient (1), target tumor image segmentation (2), the heterogeneous four-dimensional heat of inside tumor
Figure rebuilds (3), and puncture path plans (4), and 3-D image is registrated (5), AR navigation (6) in art;The present invention is directed to tumour growth mistake
The heterogeneous feature of internal room and time in journey, for taking out fraction lesion at random in the operation of existing tumor aspiration biopsy
Tissue, cannot represent this problem of complete tumors phenotype, be analysed by Quantitative image credit, excavated precisely to puncture before Tumor Resection and live
The new method of operation is examined, provides integrated subplan for Tumor Resection preplanning and operation plan customization etc..
Preferably, the preoperative image reconstruction module of the patient includes iso-surface patch and volume drawing two schemes;Described
Image includes CT/PETCT/MRI isotype medical image;Iso-surface patch process include region growing, threshold value set, manually set,
Marching cube rebuild, Laplce's smoothing processing, volume drawing include raying casting rebuild, manually divide,
Alpha setting, texture mapping.
Mainly retain contoured skin, puncturing operation thereof adjacent as manikin after further preferred, described reconstruction
Bone, upper and lower cavity aorta, tumour internal organs, tumour internal organs inside artery and vein blood vessel.
Preferably, the target tumor image segmentation is using manual plus threshold segmentation method.Pass through observation image
The area distribution of gray value and each organ-tissue, using the method for manual segmentation, first rough extracts complete tumor region,
To reduce the data volume of processing, then the region micronization processes further extracted to manual segmentation by Threshold segmentation, go
Except extra adjacent tissue and blood vessel, more accurate tumor region is obtained.
Preferably, the heterogeneous distribution that the tumour is whole, is refined as tumor surface and inside tumor is heterogeneous.
As further preferred, three-dimensional nodule normal to a surface feature obtains tumour textural characteristics after being rebuild by analysis,
Its smooth surface degree and the adhesion range with surrounding tissue are obtained, is guiding puncture to characterize tumor appearance face heterogeneity
The optimal puncture plane of biopsy offer tumor surface.
As further preferred, tumor image gray value gradient changing rule after dividing by quantitative analysis, tumour is obtained
Internal heterogeneity feature, and inside tumor heterogeneity point of maximum intensity is extracted, it draws Tumor Heterogeneity and is distributed four-dimensional visualization thermal map, make
For the target of Biopsy operation.
Preferably, the puncture path is point of puncture to the most strong target spot optimal distance of inside tumor heterogeneity;It is described
Optimal distance be to avoid patient's important organ, bone, nerve, blood vessel, the critical functions position such as tumour internal organs internal blood vessel
The shortest distance.
Refer to as further preferred, described puncture path planning, according to individual patient anatomical structure, tumor focus
Size, position and the quantitative relationship with its peripheral vessels internal organs, in conjunction with puncturing operation need to formulate paracentesis depth, puncture angle,
Point of puncture planning, the schemes such as blood vessel evacuation;Wherein paracentesis depth be from point of puncture skin to the optimal distance of tumor puncture target spot,
Puncture angle is puncture needle and punctures skin plane angle, and point of puncture is that biopsy procedure starts to puncture starting point, and blood vessel evacuation is
As far as possible and bleeding is avoided in puncture process.
Preferably, the 3-D image fusion includes that the fusion based on image and the fusion based on infrared sensor are matched
It is quasi-.
As further preferred, the integration program based on image is by two dimensional code and image calibration, by reconstruction
Tumour and trunk are merged with actual patient trunk;The fusion registration based on infrared sensor passes through the infrared biography that will be demarcated
Reference of the sensor as registration.
Preferably, AR navigation refers to through augmented reality in the art, pass through the helmet, virtual glasses, projection
Equal augmented realities watch equipment, and fused image is presented on operative doctor at the moment, so that progress tumour be instructed precisely to puncture
Biopsy procedure.
Detailed description of the invention
Fig. 1 is the step schematic diagram of the method for the present invention;
Fig. 2 is that non-small cell lung cancer (NSCLC) preoperative CT schemes (0.51*0.51*0.5mm);
Fig. 3 is NSCLC patient's three-dimensional reconstruction figure (face reconstruction);
Fig. 4 is tumour CT picture frame quantitative analysis;
Fig. 5 is the heterogeneous four-dimensional thermal map Quantitative Reconstruction of inside tumor;
Fig. 6 is tumor aspiration biopsy interface under AR navigation mode.
Specific embodiment:
It elaborates with reference to the accompanying drawing to the present invention.As shown in Fig. 1 schematic structural view of the invention, below in lung tumors
Non-small cell lung cancer (NSCLC) aspiration biopsy operation, be described further as specific embodiment, but not as this hair
Bright restriction:
Fig. 1 is the step schematic diagram of the method for the present invention, is specifically included: the preoperative CT of patient rebuilds (1), target tumor image segmentation
(2), the heterogeneous four-dimensional thermal map of inside tumor rebuilds (3), and puncture path plans (4), and 3-D image is registrated (5), AR navigation in art
(6), in which:
(1) the preoperative CT of patient is rebuild
If Fig. 2 is non-small cell lung cancer (NSCLC) aspiration biopsy operation CT image, by calling VTK to visualize in SDK
Patient image is carried out three-dimensional reconstruction by marching cube algorithm;It is drawn again by professional thoracic surgery medical practitioner by region
Divide, threshold value limits and the Data duplication assessment of generation is corrected in division manually;In the constant situation in respiratory system spatial position,
It is smoothed and texture renders, comprising: subdivided meshes, Laplce's smoothing processing, illumination, transparency are adjusted, coloring
(Shader) and the layer rendering of different structure etc., final institute model as shown in figure 3, including outer skin (translucent),
Bone (yellow), lung (pink), aorta, vein (peony) and non-small cell lung tumour (black).
(2) target tumor image segmentation
By observing the gray value of image and the area distribution of each organ-tissue, by the CT image containing lung tumors minutia
Frame carries out specially treated;The method for using manual segmentation first, first rough extracts complete tumor region, thus at reduction
The data volume of reason;The region micronization processes further extracted again to manual segmentation by Threshold segmentation, remove extra neighbour
Nearly tissue and blood vessel, obtain more accurate lung tumors region.If Fig. 4 is to be used for next step quantitative analysis lung tumors after dividing
Internal heterogeneous CT image.
(3) the heterogeneous four-dimensional thermal map of inside tumor is rebuild
The 4 D data of lung tumors refers to tumour " space three-dimensional details+heterogeneity ", here includes the table of non-small cell tumour
Face characteristic, spatial volume, maximum gauge and inside tumor are heterogeneous.We are special by the normal vector on three-dimensional nodule surface after rebuilding
Sign obtains tumour textural characteristics, its smooth surface degree and the adhesion range with surrounding tissue is obtained, to characterize tumor surface
Heterogeneity provides the optimal puncture plane of tumor surface for guiding puncture biopsy;Tumor image ash after being divided by quantitative analysis
Angle value change of gradient rule, obtains inside tumor heterogeneity feature, and extract inside tumor heterogeneity point of maximum intensity, it is different to draw tumour
Matter is distributed four-dimensional visualization thermal map, the target as Biopsy operation.If Fig. 5 is Patients with Non-small-cell Lung reconstruction
Tumour four-dimension thermal map afterwards.Wherein P ' and Q ' is the heterogeneous strongest puncture target of inside tumor after being analyzed by quantitative effect
Point.
(4) puncture path is planned
Doctor by individual patient anatomical structure, tumor focus size, position and with pulmonary artery, pulmonary vein, tracheae around it
Quantitative relationship, in conjunction with puncturing operation formulate paracentesis depth, puncture angle, point of puncture planning, blood vessel avoid scheme;Wherein puncture
Depth planning, here the planning path of two patients of lung tumors be respectively between 7,8 rib cages between 4,5 rib cages, keeping away
Under the premise of opening pulmonary artery, vein, the minimum range from point of puncture skin to tumor puncture target spot is respectively 11.3cm and 12.1cm,
Prediction excitation biopsy depth is 1.5cm-2.2cm;Needle angle is 67 degree of oblique inserting needle and vertical inserting needle, puncture angle biopsy needle-like
Number be 18G Ahmedabad biopsy needle.
(5) 3-D image is registrated
Lung tumors three registrations carry out fusion calibration by placing infrared sensor with patient, we are red provided with 19
Outer sensor, wherein during lung puncture 16 be recognized by the system and demarcate, fusion accuracy 6.7mm, thus will rebuild
Tumour and trunk merged with actual patient trunk.
(6) AR navigates in art
External augmented reality equipment (HTCVIVE) is connected, by operative image real-time transmission to the helmet with three-dimensional display function
Or large screen projection is shown, to feeling of immersion operation and operation teaching;It is illustrated in figure 6 and doctor is presented on by the enhancing display helmet
Raw fusion scene at the moment.Surgery planning path, tumoral character etc. can be presented in real time doctor at the moment.
The above is only a kind of embodiments of the invention, it is noted that for the those of ordinary skill of technical field,
Improvement and polishing without departing from the principles of the present invention, are all considered as protection scope of the present invention.
Claims (7)
1. one kind guides the accurate needle biopsy method of tumour for image, it is characterised in that: the preoperative image reconstruction of patient (1), mesh
Tumor image segmentation (2) is marked, the heterogeneous four-dimensional thermal map of inside tumor rebuilds (3), and puncture path plans (4), 3-D image registration
(5), AR navigates (6) in art.
2. according to claim 1, the preoperative image reconstruction of patient (1), including iso-surface patch and volume drawing two schemes;Described
Image includes CT/PETCT/MRI isotype medical image;Iso-surface patch process include region growing, threshold value set, manually set,
Marching cube reconstruction, Laplce's smoothing processing;Volume drawing include raying casting rebuild, manually divide,
Alpha setting, texture mapping;Manikin mainly retains contoured skin, puncturing operation thereof adjacent bone, upper and lower cavity after reconstruction
Aorta, tumour internal organs, tumour internal organs inside artery and vein blood vessel.
3. target tumor image segmentation (2) includes manual and threshold segmentation method according to claims 1, pass through observation
The area distribution of the gray value of image and each organ-tissue, using the method for manual segmentation, first rough extracting is complete swollen
Tumor region to reduce the data volume of processing, then further refines the region that manual segmentation extracts by Threshold segmentation
Processing, removes extra adjacent tissue and blood vessel, obtains more accurate tumor region.
4. according to claim 1, the heterogeneous four-dimensional thermal map of inside tumor rebuilds (3), it is characterized in that: it is rebuild by analysis
Three-dimensional nodule normal to a surface feature obtains tumour textural characteristics afterwards, obtains its smooth surface degree and the adhesion with surrounding tissue
Range provides the optimal puncture plane of tumor surface to characterize tumor appearance face heterogeneity for guiding puncture biopsy;By fixed
Tumor image gray value gradient changing rule after amount analysis segmentation, obtains inside tumor heterogeneity feature, and extract inside tumor
Heterogeneous point of maximum intensity draws Tumor Heterogeneity and is distributed four-dimensional visualization thermal map, the target as Biopsy operation.
5. according to claim 1, described in 4, puncture path plans (4), it is characterized in that: the puncture path arrives for point of puncture
The most strong target spot optimal distance of inside tumor heterogeneity;The optimal distance is to avoid patient's important organ, bone, nerve, blood
Pipe, the shortest distance at the critical functions position such as tumour internal organs internal blood vessel.
6. according to claim 1, described in 4,5,3-D image is registrated (5), it is characterized in that: the integration program based on image passes through
Two dimensional code and image calibration merge the tumour of reconstruction and trunk with actual patient trunk;It is described based on infrared sensor
Fusion registration passes through reference of the infrared sensor that will be demarcated as registration.
7. according to claim 1, AR navigates (6) in art, it is characterized in that: increased by the helmet, virtual glasses, projection etc.
Strong reality viewing equipment, is presented on operative doctor at the moment for fused puncture target spot image, to instruct progress tumour accurate
Aspiration biopsy operation.
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Cited By (18)
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CN110313979A (en) * | 2019-07-03 | 2019-10-11 | 中南大学湘雅医院 | Puncture positioning device in a kind of plane of ultrasound |
CN110420050A (en) * | 2019-07-18 | 2019-11-08 | 沈阳爱健网络科技有限公司 | CT Conducted Puncture method and relevant apparatus |
CN111640118A (en) * | 2019-03-01 | 2020-09-08 | 西门子医疗有限公司 | Tumor tissue characterization using multi-parameter magnetic resonance imaging |
CN112386332A (en) * | 2020-11-03 | 2021-02-23 | 浙江赛弘众智网络科技有限公司 | AR/MR display method and system for lung argon-helium scalpel operation path data |
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CN113057665A (en) * | 2021-03-18 | 2021-07-02 | 上海卓昕医疗科技有限公司 | Lung image three-dimensional imaging method and system |
CN113081257A (en) * | 2019-12-23 | 2021-07-09 | 四川医枢科技股份有限公司 | Automatic planning method for operation path |
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CN115770104A (en) * | 2022-11-24 | 2023-03-10 | 中国医学科学院北京协和医院 | Method for positioning thoracic dorsal root ganglion and presetting puncture path |
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CN114129240A (en) * | 2021-12-02 | 2022-03-04 | 推想医疗科技股份有限公司 | Method, system and device for generating guide information and electronic equipment |
CN114271912A (en) * | 2021-12-22 | 2022-04-05 | 苏州睿酷医疗科技有限责任公司 | Medical puncture surgery navigation system and method |
CN115770104A (en) * | 2022-11-24 | 2023-03-10 | 中国医学科学院北京协和医院 | Method for positioning thoracic dorsal root ganglion and presetting puncture path |
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CN117731376A (en) * | 2024-02-20 | 2024-03-22 | 四川省肿瘤医院 | Gynecological tumor image preoperative intelligent guiding and identifying system |
CN117731376B (en) * | 2024-02-20 | 2024-04-19 | 四川省肿瘤医院 | Gynecological tumor image preoperative intelligent guiding and identifying system |
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