CN116492049A - Method and device for determining conformal ablation range of prostate - Google Patents
Method and device for determining conformal ablation range of prostate Download PDFInfo
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Abstract
The application provides a method and a device for determining a prostate conformal ablation range, comprising the following steps: acquiring an image set of cross-sectional images of the prostate region, the image set comprising a plurality of cross-sectional images that are parallel to one another from a bladder neck location to a prostate tip or middle location; determining a first ablation boundary point based on the cross-sectional image of the bladder neck location and a second ablation boundary point based on the cross-sectional image of the prostate tip or mid-location; an ablation range for each of the remaining cross-sectional images in the image set is determined based on a first ablation boundary point of the cross-sectional image of the bladder neck location and a second ablation boundary point of the cross-sectional image of the prostate tip or mid-location. The method provides operation guidance for the prostate hyperplasia excision operation for doctors or operators, can greatly improve the maximum urine flow rate index, and effectively realizes the prostate conformal ablation.
Description
Technical Field
The present application relates to the technical fields related to image processing, surgery simulation and planning implemented and completed by a computer program, and in particular to the field of ablation surgery for prostatic hyperplasia, and more particularly to a method and apparatus for determining a prostate conformal ablation range for guiding a prostate ablation surgery.
Background
Benign prostatic hyperplasia, also known as prostatic hypertrophy, is one of the most common benign diseases causing urination disorders in middle-aged and elderly men, and is one of the most common diseases in clinical diagnosis and treatment of global urology surgery. Epidemiological histology has an increasing incidence of BPH with age, typically occurring after age 40, with an incidence of BPH greater than 50% in the 60 year old male population, up to 83% at age 80. Is mainly manifested by hyperplasia of the interstitial and glandular components of the prostate, anatomically enlarged prostate (benign prostatic enlargement, BPE), urodynamic bladder outlet obstruction (bladder outletobstruction, bo) and clinical symptoms mainly including the following urinary tract symptoms (LUTS).
Benign prostatic hyperplasia is mainly characterized by the prostatic inner gland surrounding the urethra, and the continuously-proliferated gland extrudes the prostatic outer gland to form a prostatic surgery envelope. Benign prostatic hyperplasia surgery open surgery and enucleation-like surgery to remove the proliferated endoglands, leaving the surgical envelope as a therapeutic modality. Evaluation of the effect of ablation procedures on prostatic hyperplasia is multifaceted, with the measurement of maximum urine flow rate (Qmax) being a key indicator for objective evaluation. The maximum uroflow rate is the peak of the immediate uroflow rate value curve that is continuous with the uroflow meter (uroflow chart recorder) tracing down the urination process. The maximum urine flow rate is calculated in milliliters per second. The maximum urine flow rate suggests a combination of bladder and urethra functions in the subject when urinating. The effect of the prostatic hyperplasia ablation surgery is evaluated clinically by measuring the maximum urine flow rate.
At present, various ablation operations aiming at prostatic hyperplasia are mostly performed by maximally ablating or enucleating the hyperplasia tissues along the prostate capsule layer, the operation treatment time is short for 1 to 2 hours, and patients need to be in an anesthetic state for a long time, so that anesthetic risks exist. The operator also holds the endoscope for a long time to operate, and the physical effort is very large. In addition, after the hyperplastic tissue is completely resected by the operation mode, a spherical cavity is formed, and during urination, urine forms vortex in the spherical cavity, so that the maximum urine flow rate index is not remarkably improved.
How to improve the operation mode of the prostatic hyperplasia so as to obtain better operation effect, in particular how to set or improve the operation scheme of the ablation operation aiming at the prostatic hyperplasia so as to guide the ablation operation, reduce the operation time, improve the operation accuracy, furthest improve the maximum urine flow rate index and obtain the best operation effect, which is a technical problem to be solved in the field.
Disclosure of Invention
In order to solve the technical problems, the application provides a concept of prostate conformal ablation, namely, the prostate ablation surgery scheme is optimized through optimizing a surgery path planning scheme, and the surgery effect is optimized, so that the smoothness of the urethra of a patient can be effectively recovered after surgery, and the maximum urine flow rate is obviously improved.
The application provides a method for determining a prostate conformal ablation range, which is characterized by comprising the following steps: acquiring an image set of cross-sectional images of the prostate region, the image set comprising a plurality of cross-sectional images that are parallel to one another from a bladder neck location to a prostate tip or middle location; determining a first ablation boundary point based on the cross-sectional image of the bladder neck location and a second ablation boundary point based on the cross-sectional image of the prostate tip or mid-location; an ablation range for each of the remaining cross-sectional images in the image set is determined based on a first ablation boundary point of the cross-sectional image of the bladder neck location and a second ablation boundary point of the cross-sectional image of the prostate tip or mid-location.
Preferably, the method further comprises the following steps: determining an ablation range of the cross-sectional image of the bladder neck finish location based on the first ablation boundary point, and determining an ablation range of the cross-sectional image of the prostate tip or mid-region location based on the second ablation boundary point.
Preferably, the method further comprises the following steps: fitting based on the first ablation boundary points to obtain contour lines, and taking the area in the contour lines as an ablation range of the cross-sectional image of the bladder neck position; and fitting based on the second ablation boundary points to obtain a contour line, and taking the area in the contour line as an ablation range of the cross-sectional image of the position of the tip or the middle part of the prostate.
Preferably, the method further comprises the following steps: marking a first surgical envelope boundary on the cross-sectional image of the bladder neck site and a second surgical envelope boundary on the cross-sectional image of the prostate tip or mid site; the ablation range of the bladder neck position determined in the step S3 does not exceed the first surgical envelope boundary, and the ablation range of the prostate tip or middle position does not exceed the second surgical envelope boundary.
Preferably, the method further comprises the following steps: marking a first urethra boundary on the cross-sectional image of the bladder neck position, and determining the first ablation boundary point by taking a point in the range of the first urethra boundary as a starting point; and marking a second urethral boundary on the cross-sectional image of the prostate tip or mid-region location, the second ablation boundary point being determined using a point within the range of the second urethral boundary as a starting point.
Preferably, the method further comprises the following steps: and respectively selecting one or more characteristic points as a first ablation boundary point and a second ablation boundary point on the ablation region contour line of the cross-sectional image of the bladder neck position and the ablation region contour line of the cross-sectional image of the prostate tip or middle position.
Preferably, the method further comprises the following steps: and respectively determining a first ablation boundary point and a second ablation boundary point according to the shape parameters of the outline of the ablation region.
Preferably, the method further comprises the following steps: and determining an ablation boundary point on each of the rest cross-sectional images in the image set based on the first ablation boundary point and the second ablation boundary point, and determining an ablation range of each cross-sectional image according to the determined ablation boundary point on each cross-sectional image.
Preferably, the ablation boundary points on each of the remaining cross-sectional images in the image set are determined according to the following formula: r is R ij =R 0j -D i ×|R 0j -R Lj i/D, where i denotes the number of cross-sectional images, j denotes the number of ablation boundary points on each cross-sectional image, i=0, 1 … … L, j=1, 2 … … n, R ij Representing a cross-sectional image F i The position parameter of the determined ablation boundary point is F, and the cross-sectional image of the bladder neck position is F i (i=0), the cross-sectional image at the tip or middle position of the prostate is F i (i=l), the position parameter of the first ablation boundary point is R 0j The position parameter of the second ablation boundary point is R Lj ，D i Is a cross-sectional image F i (i=1, 2 … … L-1) and cross-sectional image F 0 The distance between D is the cross-sectional image F 0 And cross-sectional image F L Distance between them.
Preferably, the method further comprises the step of combining the predicted value of the tendency to collapse of the prostate as an optimized ablation range on the basis of the determined ablation range.
The application also proposes a device for determining the range of conformal ablation of the prostate, characterized in that it comprises: an image acquisition module for acquiring an image set of cross-sectional images of the prostate region, the image set comprising a plurality of cross-sectional images of the bladder neck from a location at the apex or mid-region of the prostate that are parallel to each other; an ablation boundary point determination module comprising: a first ablation boundary point determination module for determining a first ablation boundary point based on the cross-sectional image of the bladder neck position; and a second ablation boundary point determination module for determining a second ablation boundary point based on the cross-sectional image of the prostate tip or mid-region location; and the ablation range determining module is used for determining the ablation range of each other cross-sectional image in the image set based on the first ablation boundary point of the cross-sectional image of the bladder neck position and the second ablation boundary point of the cross-sectional image of the prostate tip or middle position.
Preferably, the ablation range determination module further includes: a first ablation range determination module for determining an ablation range of a cross-sectional image of the bladder neck opening location based on the first ablation boundary point; and a second ablation range determination module for determining an ablation range of the cross-sectional image of the prostate tip or mid-position based on the second ablation boundary point.
Preferably, the first ablation range determining module fits to obtain a contour line based on the first ablation boundary point, and takes a region in the contour line as an ablation range of the cross-sectional image of the bladder neck position; and the second ablation range determining module fits the second ablation boundary points to obtain a contour line, and takes the area in the contour line as the ablation range of the cross-sectional image of the tip or middle position of the prostate.
Preferably, the ablation boundary point determination module marks a first surgical envelope boundary on a cross-sectional image of the bladder neck location and marks a second surgical envelope boundary on a cross-sectional image of the prostate tip or mid location; the ablation range of the bladder neck opening position determined by the ablation range determination module does not exceed the first surgical envelope boundary, and the ablation range of the prostate tip or middle position does not exceed the second surgical envelope boundary.
Preferably, the ablation boundary point determination module further comprises: a first urethral boundary marking module, configured to mark a first urethral boundary on a cross-sectional image of the bladder neck opening position, where the first ablation boundary point determining module determines the first ablation boundary point with a point within the range of the first urethral boundary as a starting point; and a second urethral boundary marking module for marking a second urethral boundary on a cross-sectional image of the prostate tip or middle position, the second ablation boundary point determination module determining the second ablation boundary point with a point within the range of the second urethral boundary as a starting point.
Preferably, the ablation boundary point determining module selects one or more characteristic points as a first ablation boundary point and a second ablation boundary point on an ablation area contour line of the cross-sectional image of the bladder neck position and an ablation area contour line of the cross-sectional image of the prostate tip or middle position respectively.
Preferably, the ablation boundary point determining module determines the first ablation boundary point and the second ablation boundary point according to the shape parameters of the region outline.
Preferably, the ablation range determining module determines an ablation boundary point on each of the rest of the cross-sectional images in the image set based on the first ablation boundary point and the second ablation boundary point, and determines an ablation range of each of the cross-sectional images according to the determined ablation boundary point on each of the cross-sectional images.
Preferably, the ablation scope determination module determines the ablation boundary points on each of the remaining cross-sectional images in the image set according to the following formula: r is R ij =R 0j -D i ×|R 0j -R Lj i/D, where i denotes the number of cross-sectional images, j denotes the number of ablation boundary points on each cross-sectional image, i=0, 1 … … L-1, j=1, 2 … … n, R ij Representing a cross-sectional image F i The position parameter of the determined ablation boundary point is F, and the cross-sectional image of the bladder neck position is F i (i=0), the cross-sectional image at the tip or middle position of the prostate is F i (i=l), the position parameter of the first ablation boundary point is R 0j The position parameter of the second ablation boundary point is R Lj ，D i Is a cross-sectional image F i (i=1, 2 … … L-1) and cross-sectional image F 0 The distance between D is the cross-sectional image F 0 And cross-sectional image F L Distance between them.
Preferably, the ablation range determination module combines the predicted value of the tendency to collapse of the prostate as an optimized ablation range based on the determined ablation range.
Preferably, the image acquisition module includes: a prostate stereoscopic image acquisition module, a TRUS rectal ultrasound image acquisition module and an image fusion module.
The application also provides an electronic device comprising: a processor, a memory and a computer program stored on the memory and executable on the processor, the computer program being executed by the processor to perform the steps of the aforementioned method of determining a conformal ablation range of a prostate.
The present application also provides a computer readable storage medium having stored thereon a computer program which, when executed by a processor, implements the steps of the aforementioned method of determining a conformal ablation range of a prostate.
The present application also provides a prostate conformal ablation surgical system comprising: the ablation device, the imaging device and the surgical robot device further comprise the electronic equipment or the computer readable storage medium, and the method can execute the steps of the method for determining the conformal ablation range of the prostate and can complete the conformal ablation surgery according to the determined ablation range.
The above-mentioned at least one technical scheme that this application embodiment adopted can reach following beneficial effect at least:
the method and the device can greatly improve the maximum urine flow rate index by carrying out the processes such as identification, calculation and the like on the image of the prostate region, and the determined ablation range is used as the guide of a doctor or an operator for carrying out the operation of the prostate hyperplasia excision. The application can work cooperatively with a prostate hyperplasia surgical robot ablation system, and the energy platform can adopt electrotome and/or laser and/or water jet and/or hot steam and the like. According to the method and the device provided by the application, the optimal ablation range of prostate ablation can be rapidly given in a short time, so that the operation time is shortened, the operation efficiency is greatly improved, the working intensity of medical staff can be effectively reduced, the safety of an operation is ensured, the help is provided for realizing accurate operation, the optimal operation index of the maximum postoperative urine flow rate can be realized, and the operation effect is greatly improved.
Drawings
The accompanying drawings, which are included to provide a further understanding of the application and are incorporated in and constitute a part of this application, illustrate embodiments of the application and together with the description serve to explain the application and do not constitute an undue limitation to the application. In the drawings:
fig. 1 is a flowchart illustrating steps of a method for determining a conformal ablation scope of a prostate according to an embodiment of the present application.
Fig. 2 is a schematic block diagram of a device for determining a prostate conformal ablation range according to an embodiment of the present application.
Fig. 3 is a schematic illustration of a urethral boundary and a surgical capsule boundary identified and marked in a prostate cross-sectional image according to an embodiment provided herein.
Fig. 4 is a schematic coronal view of a prostate-conforming ablation plan range as determined in accordance with an embodiment of the present application.
Detailed Description
For the purposes, technical solutions and advantages of the present application, the technical solutions of the present application will be clearly and completely described below with reference to specific embodiments of the present application and corresponding drawings. It will be apparent that the described embodiments are only some, but not all, of the embodiments of the present application. All other embodiments, which can be made by one of ordinary skill in the art without undue burden from the present disclosure, are within the scope of the present disclosure.
Referring to fig. 1, an embodiment of the present application provides a method for determining a prostate conformal ablation range, including the steps of: acquiring an image set of cross-sectional images of the prostate region, the image set comprising a plurality of cross-sectional images that are parallel to one another from a bladder neck location to a prostate tip or middle location; determining a first ablation boundary point based on the cross-sectional image of the bladder neck location and a second ablation boundary point based on the cross-sectional image of the prostate tip or mid-location; an ablation range for each of the remaining cross-sectional images in the image set is determined based on a first ablation boundary point of the cross-sectional image of the bladder neck location and a second ablation boundary point of the cross-sectional image of the prostate tip or mid-location. The above steps are described in detail below.
Step S1: an image set of cross-sectional images of the prostate region is acquired.
The image set contains a plurality of cross-sectional images obtained by scanning or slicing the prostate region. The prostate is a solid organ shaped like an inverted cone, and has a normal size of about 3.5cm wide, an upper and lower diameter of about 2.5cm, an anterior and posterior diameter of about 2.5cm, and a urethra passing therethrough. The upper end of the prostate is wide, anatomically commonly called the prostatic fundus, upwardly adjoins the bladder neck and connects to the seminal vesicle gland and the ampulla of the vas deferens, narrowing down gradually to form the lower prostate tip, and the lowest meets the upper fascia of the urogenital diaphragm and migrates with the urethra. Between the tip and the bottom is a prostate body. The image set acquired in this embodiment contains a plurality of cross-sectional images from the bladder neck location to the prostate tip or middle location.
In some embodiments, the position of the tip of the prostate is the position of the urethral orifice, and in the following image processing steps S2 and S3, the processing of the cross-sectional image of the position of the tip of the prostate refers to the processing of the cross-sectional image of the position of the urethral orifice of the tip of the prostate, at this time, the determined ablation range can achieve the maximum urine flow rate, and according to the ablation range determined in the embodiment of the present application, the operation planning and the specific operation can achieve the complete conformal ablation of the prostate, and the eddy current effect is reduced to the greatest extent after the operation, so as to achieve the maximum urine flow rate index.
In other embodiments, the middle position of the prostate is the position of the verruca, and in the subsequent image processing steps S2 and S3, the cross-sectional image processing of the middle position of the prostate refers to the processing of the cross-sectional image of the middle position of the verruca, at this time, the determined ablation range can achieve the maximum urine flow rate in the safe mode, and according to the ablation range determined in the embodiment of the present application, the operation planning and the specific operation can achieve the more complete conformal ablation safe to the prostate, the eddy effect is reduced to a greater extent after the operation, and the maximum urine flow rate index in the safe mode is achieved.
As used herein, the term "cross-sectional image" encompasses not only cross-sectional images of human prostate tissue in the general sense of stricture, but also cross-sectional images that are at an oblique angle to the cross-sectional plane in the sense of stricture, but still characterize the cross-sectional information of the prostate tissue.
The cross sections of the plurality of cross-sectional images contained in the image set are parallel to each other in the physical space, and adjacent cross-sectional images have a pitch in the physical space. The smaller the spacing, the higher the accuracy of the surgical planning.
According to an embodiment of the application, the distance is set to be approximately 1mm, so that on one hand, the accuracy of operation planning can be guaranteed, and on the other hand, the efficiency and convenience of calculation of the processor can be considered.
In some embodiments, the pitch may be a fixed value, with the distance between adjacent cross-sectional images being equally spaced. However, in other embodiments, the spacing may also be varied, and the distance spacing between adjacent cross-sectional images need not necessarily be equal.
According to an embodiment of the present application, the image set is preferably acquired by means of transrectal ultrasound (TRUS) scanning. In TRUS, an ultrasound probe is inserted into a patient's rectum while scanning the patient's prostate to obtain a plurality of cross-sectional ultrasound images with a spacing between adjacent ones of the plurality of cross-sectional ultrasound images. And, in TRUS, an ultrasound probe stepper may be employed to automatically or manually drive the ultrasound probe into the patient's rectum and acquire a cross-sectional ultrasound image set. When an ultrasound probe stepper is used, it may be advantageous to acquire a set of cross-sectional images of the patient's prostate in real time, which set of images more accurately represents the patient's condition, which is preferred. In some embodiments, obtaining information from at least one of a position sensor or a pressure sensor located in the ultrasound probe may also be included to facilitate accurate positioning and registration of images of the cross-sectional image set.
In some embodiments, a cross-sectional ultrasound image set for the prostate site may also be acquired using other means such as trans-abdominal/urethral or other means of ultrasound scanning.
In some embodiments, the set of images required by the present application may also be obtained by obtaining three-dimensional (3D) scan images of the patient's prostate, slicing the obtained three-dimensional scan images at a certain pitch.
In some embodiments, other modality imaging such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) may be used to obtain a three-dimensional scan of the prostate region of the patient, and then the portion of the three-dimensional scan containing the prostate is segmented from the bladder neck position to the tip urethral position (or the mid-vernier position) into a plurality of spaced cross-sections, creating a cross-sectional image set of the prostate region.
In some embodiments, a prostate stereoscopic image acquisition module, a TRUS rectal ultrasound image acquisition module, and an image fusion module may be provided. The system comprises a prostate stereoscopic image acquisition module, a control module and a control module, wherein the prostate stereoscopic image acquisition module acquires a stereoscopic image of a prostate tissue before operation through a Magnetic Resonance (MRI) or a Computed Tomography (CT) or a three-dimensional ultrasonic scanning mode; the TRUS rectal ultrasonic image acquisition module is used for acquiring a real-time ultrasonic cross-section image set of the prostate region in the process of inserting an ultrasonic probe into the rectum of a patient and advancing in the operation; the image fusion module fuses the stereoscopic image of the operation prostate tissue with the image in the real-time prostate area ultrasonic cross-section image set to obtain the more accurate and higher-definition prostate area cross-section image set. In such embodiments, efficiency and sharpness may be better compromised, so as to obtain a clearer image in real time and conveniently, which is more beneficial to the image processing in the subsequent steps S2 and S3 and the determination of a more accurate ablation range.
By F i Each image in the image set is represented, i represents the number, the cross-sectional image at the bladder neck position is denoted as i=0, the image number at the prostate tip or middle position is denoted as i=l, the image set is represented by image F i (wherein i=0, 1,2 … … L). Will map the figureThe cross-sectional images in the image set are according to { i, F i The means of storage for image processing of the following steps S2, S3.
Step S2: comprising the step S21 of: cross-sectional image F based on bladder neck position 0 Determining a first ablation boundary point of the cross-sectional image of the bladder neck location, and step S22: cross-sectional image F based on the position of the tip or middle of the prostate L A second ablation boundary point of the cross-sectional image of the prostate tip or mid-region location is determined in the same manner. Step S21 and step S22 are not sequential in time sequence, and step S21 may be performed first, then step S22 may be performed, or step S21 may be performed first, or step S21 and step S22 may be performed simultaneously.
The detailed procedure will be explained below taking step S21 as an example. S21 further comprises the steps of:
first, from the image set { i, F i In the }, a cross-sectional image F of the bladder neck position i=0 is acquired 0 The method comprises the steps of carrying out a first treatment on the surface of the For cross-sectional image F 0 Image processing is carried out, and cross-sectional image F is identified and marked 0 First urethral boundary I 0 And a first surgical envelope boundary O 0 . The urethral boundary is shown as inner circle I in fig. 3, and the surgical envelope boundary is shown as outer circle O in fig. 3. The urethral boundary may be determined by distinguishing urethral mucosa tissue from prostate tissue on an image, or may be determined in combination with image recognition of the contours of a catheter inserted into the urethra. The surgical envelope boundary is also an inner and outer envelope boundary, is different from the prostate envelope, has a more obvious boundary with an enlarged internal gland due to the fact that the prostate gland is pressed and thinned, and takes an ultrasonic image as an example, and reflects the obvious enhancement characteristic on the image.
For the first urethra boundary I 0 And a first surgical envelope boundary O 0 The identification method of (a) may be any of various image identification methods (for example, gray matrix) commonly used in the art, as long as the boundary information can be identified and marked. In some embodiments, the means of identifying may include segmenting the acquired image using a machine learning model trained to identify one or more different types of anatomical landmarks. In other embodiments, it is possible toDifferent types of machine learning models are used to identify urethral and surgical capsule boundaries, such as linear classifiers, naive bayes classifiers, kernel density estimation classifiers, decision tree classifiers, support vector machine classifiers, maximum entropy classifiers, and/or other types of classifiers. Preferably, the accuracy of image feature extraction can be enhanced by a multi-layer convolutional neural network algorithm.
With a first urethral boundary I 0 One or more points within the defined range (i.e. the urethral boundary and the contour defined by the urethral boundary, which may also be referred to as the urethral region) are taken as starting points, and from the selected points as starting points, the contour lines are connected to the periphery without exceeding the first surgical envelope boundary O 0 Within a range of (a) a location parameter of the first ablation boundary point is determined. The peripheral outline is a broad concept and can be understood as a surgical envelope which has been identified, and can be understood as a direction which spreads in the peripheral direction of the entire image centering on a point in the urethra area.
The location parameter of the first ablation boundary point may be a numerical value or a set of numerical values. The application adopts R 0j (j=1, 2,3 … … n) wherein n is a natural number equal to or greater than 1, and when n is 1, R is a position parameter characterizing the first ablation boundary point 0j Is a numerical value, when n is a natural number greater than 1, R 0j Is a set of values. The greater the value of n, the higher the accuracy of achieving the predetermined objective. The value of n is preferably more than 4 to facilitate more accurate planning and execution of the plan.
After the departure point is selected, R is characterized by a value of one or more distances from the departure point to the boundary point 0j 。
When the starting point is selected in the urethral region within the boundary range of the first urethra, the limit position point on the boundary contour can be selected, for example, when 4 starting points are required to be selected, the leftmost, rightmost, uppermost and bottommost points on the boundary contour are selected as the starting points, so that the planning range which is more matched with the tissue geometry of the patient can be realized.
In a more preferred embodiment, since the urethral boundary is not regularly circular, the flow throughThe method is characterized in that the method is usually elliptical and accompanied by irregular deformation, so that firstly, an elliptical-like contour is used for fitting the urethral boundary, the center of the elliptical-like contour is used as the center position of the urethral boundary contour, the center position is used as a starting point, n ablation boundary points are sequentially selected and determined clockwise or anticlockwise according to a certain angle interval, and n distance values from the center position to the n ablation boundary points are used as position parameters R of a first ablation boundary point 0j (j=1, 2,3 … … n). In the case of a processor with limited computation time, the ablation boundary point determination is more efficient.
After the departure point is selected, the cross-sectional image F can also be followed 0 The horizontal direction of the line is extended to the peripheral outline, and then the line is extended from the horizontal direction, the rest line directions are obtained by increasing the preset angle according to the clockwise or anticlockwise sequence, and the distance from the starting point to the boundary point in each line direction is determined, and a group of position parameter values are obtained and used as the cross section image F 0 Location parameter R of first ablation boundary point on 0j （j=1，2，3……n）。
In some embodiments, a plurality of (j) departure points may be selected for the urethral region within the first urethral boundary, and the peripheral contours may be connected by connecting lines from the selected j departure points to the peripheral contours without exceeding the first surgical capsule boundary O 0 Respectively determining the distances of j ablation boundary points corresponding to j points, and obtaining a group of distance values as a cross-sectional image F 0 Location parameter R of first ablation boundary point on 0j （j=1，2，3……n）。
In the previous embodiment, the location parameter R of the first ablation boundary point 0j (j=1, 2,3 … … n) is a set of distance values, the magnitude of which can be dynamically adjusted according to the surgical object, e.g. a larger distance value is selected when a larger area ablation is desired or required, and a smaller distance value is selected when a smaller area ablation is desired. The present application is not limited in this regard.
According to other embodiments, cross-sectional image F 0 The contour of the ablation zone is known or can be determined by knownOther ways of determining, in which case, in determining the first and second ablation boundary points, the first and second ablation boundary points may be directly determined in the cross-sectional image F 0 Selecting one or more characteristic points on the contour line of the ablation range as first ablation boundary points, and taking the distance value between the selected characteristic points and points in the urethral boundary range on the cross-sectional image as the position parameter R of the first ablation boundary points 0j （j=1，2，3……n）。
Cross-sectional image F at the tip or middle position of the prostate in the same manner as the preceding steps L The position parameter R of the second ablation boundary point is determined Lj (j=1, 2,3 … … n). It should be emphasized that, although the selection of the departure point of the different urethral boundary and the determination of the different ablation boundary point and its position parameters are given above, steps S21 and S22 are performed in the selection of the departure point on the urethral boundary and in the determination of the ablation boundary point based on the selected departure point, in the cross-sectional image F 0 And F L The steps performed thereon must be consistent.
The term "ablation boundary point" as used herein refers to a point used to determine or associated with an ablation boundary, and the ablation boundary point may be one or more.
In the previous embodiment, the location parameter R of the ablation boundary point ij By characterizing a set of distance values from points within the urethral boundary to selected feature points, however, in other embodiments, the location parameters of the ablation boundary points may also be characterized by shape parameters associated with determining the profile of the ablation range, e.g., when the profile defining the ablation range is circular or elliptical, the location parameters of the location ablation boundary points may be characterized by key features such as circular radius or elliptical major axis length, minor axis length, deformation coefficients, etc. Further, the following steps are included in such embodiments: and respectively determining a first ablation boundary point and a second ablation boundary point according to the shape parameters of the outline of the ablation region.
Step S3: determining a set of cross-sectional images F i (where i=0, 1,2 … … L).
An "ablation zone" in this application is a target ablation zone that may be represented as a pattern having an area, with subsequent procedures performed according to the determined ablation zone in order to ablate tissue within the ablation zone.
Step S3 further comprises the steps of: step S31: position parameter R based on first ablation boundary point 0j (j=1, 2,3 … … n) determination of the transverse image F of the bladder neck position 0 Is an ablation range S of (2) 0 The method comprises the steps of carrying out a first treatment on the surface of the Step S32: position parameter R based on second ablation boundary point Lj (j=1, 2,3 … … n) determination of the cross-sectional image F of the tip or middle position of the prostate L Is an ablation range S of (2) L . Step S31 and step S32 are not sequential in time sequence, and step S31 may be performed first, then step S32 may be performed first, or step S32 may be performed first, then step S31 may be performed, or step S31 and step S32 may be performed simultaneously.
The following takes step S31 as an example, and the detailed steps are explained, and step S31 can be implemented as follows:
since the position parameter of the first ablation boundary point is one or a group of values, the position parameter R of the ablation boundary point can be obtained 0j (j=1, 2,3 … … n) directly as an ablation range S 0 Parameters for surgical planning.
More preferably, however, the first ablation boundary points are curve-fitted to obtain a fitted boundary profile, and the ablation range S is determined based on the area defined by the boundary profile 0 In this embodiment, fitting to a circular or elliptical-like profile is preferred, as the overall circular arc-shaped cross-section is more conducive to urine drainage and reduces the vortex effect.
Fit-after ablation range S 0 Should not exceed the surgical envelope boundary O marked in the preceding step 0 。
In the same manner as in step S31, an ablation range S of the tip or middle position of the prostate is determined L The method comprises the steps of carrying out a first treatment on the surface of the And, it should be understood that the execution of step S31 and step S32 is not sequential, and neither of the execution of the steps is performed first or the execution of the steps is performed simultaneously does not affect the present inventionThe achievement of the object of the present invention is applied. More preferably, however, step S31 and step S32 are consistent with the manner and steps employed in determining the ablation scope.
Step S33: position parameter R based on first ablation boundary point 0j (j=1, 2,3 … … n) and a position parameter R of the second ablation boundary point Lj (j=1, 2,3 … … n) determining the remaining cross-sectional images F in the image set i (i=1, 2 … … L-1) position parameter R of ablation boundary point ij （j=1，2，3……n）；
In the present application, the position parameter of the ablation boundary point of the rest of the cross-sectional image Fi (i=1, 2 … … L-1) is the position parameter R according to the first ablation boundary point 0j (j=1, 2,3 … … n) and a position parameter R of the second ablation boundary point Lj (j=1, 2,3 … … n), on the one hand, the calculation amount can be greatly reduced, the calculation speed is favorably provided, the planning scheme is quickly determined, and more importantly, the ablation boundary points and the ablation range determined in the mode can ensure conformal ablation of the prostate, so that the planned ablation range has a shape or outline which is favorable for realizing the maximum urine flow rate.
For F i (i=1, 2 … … L-1) determining the position parameter R of the ablation boundary point of each of the cross-sectional images ij (j=1, 2,3 … … n): when the spacing between each cross-sectional image is equal, the following formula can be directly used to calculate: r is R ij =R 0j -i×|R 0j -R Lj i/L, where i=1, 2 … … L-1, j=1, 2 … … n.
For the case where there is an unequal spacing between the cross-sectional images, a more general calculation formula is as follows:
R ij =R 0j -D i ×|R 0j -R Lj i/D, where i=1, 2 … … L-1, j=1, 2 … … n, where D i Is F i And F is equal to 0 The distance between D is the image F 0 And image F L Distance between them.
S34: based on each cross-sectional image F i Ablation boundary point of (i=1, 2 … … L-1)Position parameter R of (2) ij (j=1, 2,3 … … n), and determining an ablation range S of the position corresponding to the cross-sectional image in the same manner as in step S31 or step S32 i （i=1，2……L-1）。
Step S4: ablation scope S determined according to step S3 i (i=0, 2 … … L) a simulated surgery or a real surgery is performed.
After the execution of the steps S1-S3 is finished, the prostate conformal ablation range S can be determined i (i=0, 1,2 … … L), and further, the determined ablation range S i (i=0, 1,2 … … L) as basic data of the surgical plan, according to the determined ablation range S i (i=0, 1,2 … … L) a simulated or actual operation of the prostate conformal ablation was performed.
When the position of i=l is the position of the prostatic tip urethral orifice, the prostate conformal ablation operation which is the eradication mode when the operation is performed according to the previous steps is that the proliferated internal glands are completely ablated along the surgical envelope or the internal glands which are partially proliferated are ablated. As the determined ablation range is the full-path planning for the cross-section image set, the whole ablation path is in an inverted trapezoid structure, the tissue interface after the ablation and proliferation is smooth and flat, and simulation tests show that the vortex on two sides tends to disappear, so that the maximum urine flow rate is greatly improved.
When the position of i=l is the position of the middle mons of the prostate, the prostate conformal ablation operation which is a safe mode when the operation is performed according to the previous steps. The safe mode is to ablate the proliferated internal glands properly, ablate the proliferated prostate tissue from the bladder neck to the rim of the vernal mons, and can relieve the Lower Urinary Tract Symptoms (LUTS) to a certain extent. The important point of the safety mode is to protect the urethral sphincter and the vernal mons, so that urinary incontinence and sexual dysfunction after an ablation operation can be effectively avoided. For the operation of the safe mode, the determination of the ablation range is limited to the path planning of the cross-sectional image set from the bladder neck to the position of the central mons of the prostate, and the mons of the prostate is protected to the maximum extent when the mons position planning and the operation are carried out; the ablation may be omitted or the depth of ablation reduced in the posterior aspect of the mons, i.e., from the mons to the tip urethral orifice area, to avoid or reduce damage to the external urethral sphincter. Under this mode, the scheme of the application can be adopted to realize the maximum urine flow rate under the safe mode, realize the relatively complete conformal ablation safe to the prostate, reduce the eddy current effect after operation and realize the maximum urine flow rate index under the safe mode.
Further, the method can also comprise an ablation range S determined by the steps of the method i (i=0, 1,2 … … L), namely, taking into consideration that the prostate is soft in constitution and collapses inwards after operation, the actual ablation range should be subjected to expansion correction based on the determined ablation range so as to maintain the conformal ablation effect of large urine flow rate even if collapse occurs after operation.
In some embodiments, the flare value may be set to a fixed value, e.g., d=2 mm, i.e., in the initial ablation range S i Is expanded by 2mm on the basis of the above to obtain an optimized ablation range S i '. In some embodiments, the flare value may also be dynamic, i.e., set to a dynamic value d according to the parameters of the prostate or the surgical target i By being within the initial ablation range S i Is spread d on the basis of (2) i Obtaining an optimized ablation range S i '。
Ablation range S to be optimized i The' relevant data is transmitted to the processor as robotic surgery planning data, in accordance with the determined optimized ablation scope S i ' perform a prostate ablation procedure.
The prediction of the tendency to collapse of the prostate may be generated using a machine learning model trained to output a quantitative clinical grade value for the prostate of the patient based on the determined size, volume, and/or shape. In addition, the size, volume, and/or shape of the patient's prostate may be compared to previously determined sizes, volumes, and/or shapes obtained during previous visits to determine changes in the size, volume, and/or shape of the patient's prostate. The determined change may be used to generate a predicted value of the tendency to collapse of the prostate.
In any way, the optimized ablation scope S is modified i ' should not exceed the marked surgical envelope boundary O either i 。
Preferably, the flaring correction is performed only for each of the remaining cross-sectional images Fi (i=1, 2 … … L-1) in the image set, since the bladder neck and the location of the prostatic tip meatus or medial vernius is the more critical area for which the ablation boundary point and/or ablation range is the first to be determined and can be optimally determined in conjunction with visualization or the like, and the collapse of the prostatic tissue typically occurs in the medial area with a probability of nearly 0.
As shown in fig. 4, a schematic diagram of a coronal plane of a prostate conformal ablation planning range according to an embodiment of the present application is shown, wherein 1 is a bladder, 2 is a bladder neck, 3 is a prostate, 4 is a prostatic tip urethral orifice, 5 is a urethra, 6 is an ablation plan formed after the ablation range of all cross-sectional images is determined according to the previous embodiment, and 7 is an ablation plan determined by increasing an external expansion value further considering the influence of the gland shape.
Preferably, the expansion value can be adjusted according to the surgical envelope boundary, and the expansion value can be calculated according to the following formula and the position parameter Rij of the ablation boundary point is corrected and adjusted: r is R ij ' = R ij +α×f(i)× B ij Wherein R is ij ' is a position parameter of an ablation boundary point for determining an optimized ablation range, R ij The location parameters of the boundary points of the ablation scope determined for the previous embodiments; b (B) ij Representing each cross-sectional image F i (i=1, 2 … … L-1) and the position parameter R of the ablation boundary point ij Corresponding to the above; position parameter B of surgical envelope boundary point ij The distance between the ablation boundary point and the corresponding point on the surgical envelope boundary can be the shape parameter of the surgical envelope boundary outline; alpha is an expansion value safety coefficient, which is between 0 and 1, and more between 0 and 0.3; f (i) is an empirical prediction curve coefficient of the spread value related to the cross-sectional position, and the value is between 0 and 1.
The optimized ablation range S is obtained by the mode of the expansion adjustment i '. According to this embodiment, an optimized ablation scope is combined with a predicted value of the collapse tendency of the prostate on the basis of the ablation scope determined in the preceding method steps, and an ablation procedure planning and an ablation procedure are performed according to the optimized ablation scope.
As shown in fig. 2, the present application further provides a determining device for a prostate conformal ablation range, which includes an image acquisition module, and acquires an image set of a cross-sectional image of a prostate region, where the image set includes a plurality of cross-sectional images parallel to each other from a bladder neck position to a prostate tip or middle position; an ablation boundary point determination module comprising: a first ablation boundary point determination module that determines a first ablation boundary point based on the cross-sectional image of the bladder neck location; and a second ablation boundary point determination module that determines a second ablation boundary point based on the cross-sectional image of the prostate tip or mid-region location; an ablation range determination module determines an ablation range for each of the remaining cross-sectional images in the image set based on a first ablation boundary point of the cross-sectional image of the bladder neck location and a second ablation boundary point of the cross-sectional image of the prostate tip or mid location.
According to still another embodiment of the present application, there is also provided an electronic apparatus including: a processor, a memory and a computer program stored on the memory and executable on the processor, the computer program being executed by the processor to perform the steps of the aforementioned method of determining a conformal ablation range of a prostate.
According to yet another embodiment of the present application, there is also provided a computer readable storage medium having stored thereon a computer program which, when executed by a processor, implements the steps of the aforementioned method of determining a conformal ablation range of a prostate.
There is also provided, in accordance with yet another embodiment of the present application, a system for conformal ablation of the prostate, comprising: the ablation device, the imaging device and the surgical robot device further comprise the electronic equipment or the computer readable storage medium, wherein the imaging device is used for acquiring the cross-section image set, the surgical robot device is connected with the ablation device and used for executing the steps of the method for determining the prostate conformal ablation range and completing the prostate conformal ablation operation according to the determined ablation range.
It should be appreciated that the ablation procedure may be laser ablation, or may be electrotome or water-jet ablation, or any other means of ablation known in the art, regardless of which means of ablation, the ablation scope data provided herein may be employed as ablation procedure planning parameters, and the ablation procedure performed accordingly.
A processor may include any type of single-core processor, multi-core processor, microprocessor, latch-based processor, and/or processing logic (or family of processors, microprocessors, and/or processing logic) that interprets and executes instructions. In other embodiments, the processor may include an Application Specific Integrated Circuit (ASIC), a Field Programmable Gate Array (FPGA), and/or other type of integrated circuit or processing logic.
The memory may include any type of dynamic storage device that may store information and/or instructions for execution by the processor; and/or any type of non-volatile storage device that can store information for use by the processor. For example, the memory may include Random Access Memory (RAM) or other type of dynamic storage device, read Only Memory (ROM) device or another type of static storage device, content Addressable Memory (CAM), magnetic and/or optical recording memory devices and their corresponding drives (e.g., hard disk drives, optical drives, etc.), and/or removable forms of memory such as flash memory.
And, preferably, the provided ablation surgical system further comprises a display device or user interface to provide information display and/or user interaction of any of the aforementioned images in the set of images and the ablation scope on the image determined according to the aforementioned steps of the present application.
The provided ablation surgery system further comprises an alarm device, and the alarm device gives a prompt or warning when the deviation between the actual ablation area and the calculated ablation range exceeds a threshold value. According to the ablation range determined by the embodiment provided by the application, the optimal index of the maximum postoperative urine flow rate is realized, and the cavity formed after the prostate gland is ablated according to the range can be realized to the greatest extent, so that urine outflow is facilitated.
According to the ablation range determined by the embodiment of the application, the prostate ablation operation is performed, so that the inner wall of the urethra cavity after operation is smooth and flat as much as possible, and the phenomenon that the maximum urine flow rate is reduced due to the fact that urine repeatedly impacts the prostatic fossa to form turbulence is avoided.
According to the method and the device provided by the embodiment of the application, the optimal ablation range of prostate ablation can be rapidly given in a short time, so that the operation time is shortened, the operation efficiency is greatly improved, the working intensity of medical staff can be effectively reduced, the safety of an operation is ensured, the best index of the maximum urinary flow rate after the operation can be realized, and the help is provided for realizing the accurate operation.
The foregoing is merely exemplary of the present application and is not intended to limit the present application. Various modifications and changes may be made to the present application by those skilled in the art. Any modifications, equivalent substitutions, improvements, etc. that fall within the spirit and principles of the present application are intended to be included within the scope of the claims of the present application.
Claims (17)
1. A method of determining a conformal ablation range of a prostate, the method comprising the steps of:
step S1: acquiring an image set of cross-sectional images of the prostate region, the image set comprising a plurality of cross-sectional images that are parallel to one another from a bladder neck location to a prostate tip or middle location;
step S2: determining a first ablation boundary point based on the cross-sectional image of the bladder neck location and a second ablation boundary point based on the cross-sectional image of the prostate tip or mid-location;
step S3: an ablation range for each of the remaining cross-sectional images in the image set is determined based on a first ablation boundary point of the cross-sectional image of the bladder neck location and a second ablation boundary point of the cross-sectional image of the prostate tip or mid-location.
2. The method of determining a conformal ablation range for the prostate according to claim 1, wherein step S2 further comprises: marking a first urethra boundary on the cross-sectional image of the bladder neck position, and determining the first ablation boundary point by taking a point in the range of the first urethra boundary as a starting point; and marking a second urethral boundary on the cross-sectional image of the prostate tip or mid-region location, the second ablation boundary point being determined using a point within the range of the second urethral boundary as a starting point.
3. The method of determining a conformal ablation range for the prostate according to claim 1, wherein the step S2 further comprises the steps of: and respectively selecting one or more characteristic points as a first ablation boundary point and a second ablation boundary point on the ablation region contour line of the cross-sectional image of the bladder neck position and the ablation region contour line of the cross-sectional image of the prostate tip or middle position.
4. The method of determining a conformal ablation range for the prostate according to claim 1, wherein the step S2 further comprises the steps of: and respectively determining a first ablation boundary point and a second ablation boundary point according to the shape parameters of the outline of the ablation region.
5. The method of determining a conformal ablation range for the prostate according to claim 1, wherein the step S3 further comprises the steps of: and determining an ablation boundary point on each of the rest cross-sectional images in the image set based on the first ablation boundary point and the second ablation boundary point, and determining an ablation range of each cross-sectional image according to the determined ablation boundary point on each cross-sectional image.
6. The method of claim 5, wherein the ablation boundary points on each of the remaining cross-sectional images in the set of images are determined according to the following formula: r is R ij =R 0j -D i ×|R 0j -R Lj i/D, where i denotes the number of cross-sectional images, j denotes the number of ablation boundary points on each cross-sectional image, i=0, 1 … … L, j=1, 2 … … n, R ij Representing a cross-sectional image F i The position parameter of the determined ablation boundary point is F, and the cross-sectional image of the bladder neck position is F i (i=0), the cross-sectional image at the tip or middle position of the prostate is F i (i=l), the position parameter of the first ablation boundary point is R 0j The position parameter of the second ablation boundary point is R Lj ，D i Is a cross-sectional image F i (i=1, 2 … … L-1) and cross-sectional image F 0 The distance between D is the cross-sectional image F 0 And cross-sectional image F L Distance between them.
7. The method of determining a conformal ablation range for the prostate according to claim 1, further comprising the step of combining the determined ablation range with an ablation range optimized for a predictive correction value of a tendency to collapse of the prostate.
8. A device for determining a range of conformal ablation of a prostate, the device comprising:
an image acquisition module for acquiring an image set of cross-sectional images of the prostate region, the image set comprising a plurality of cross-sectional images parallel to each other from a bladder neck position to a prostate tip or middle position;
An ablation boundary point determination module comprising: a first ablation boundary point determination module for determining a first ablation boundary point based on the cross-sectional image of the bladder neck position; and a second ablation boundary point determination module for determining a second ablation boundary point based on the cross-sectional image of the prostate tip or mid-region location;
and the ablation range determining module is used for determining the ablation range of each other cross-sectional image in the image set based on the first ablation boundary point of the cross-sectional image of the bladder neck position and the second ablation boundary point of the cross-sectional image of the prostate tip or middle position.
9. The apparatus for determining a conformal ablation range for the prostate according to claim 8, wherein said ablation boundary point determination module further comprises: a first urethral boundary marking module, configured to mark a first urethral boundary on a cross-sectional image of the bladder neck opening position, where the first ablation boundary point determining module determines the first ablation boundary point with a point within the range of the first urethral boundary as a starting point; and a second urethral boundary marking module for marking a second urethral boundary on a cross-sectional image of the prostate tip or middle position, the second ablation boundary point determination module determining the second ablation boundary point with a point within the range of the second urethral boundary as a starting point.
10. The apparatus according to claim 8, wherein the ablation boundary point determining module selects one or more feature points as the first ablation boundary point and the second ablation boundary point on an ablation region contour line of the cross-sectional image of the bladder neck position and an ablation region contour line of the cross-sectional image of the prostate tip or middle position, respectively.
11. The apparatus according to claim 8, wherein the ablation boundary point determining module determines the first ablation boundary point and the second ablation boundary point according to shape parameters of the region outline, respectively.
12. The apparatus of claim 8, wherein the ablation range determination module determines an ablation boundary point on each of the remaining cross-sectional images in the image set based on the first ablation boundary point and the second ablation boundary point, and determines the ablation range of each cross-sectional image from the determined ablation boundary points on that cross-sectional image.
13. The apparatus for determining a conformal ablation range for the prostate according to claim 12, wherein: the ablation scope determination module determines ablation boundary points on each of the remaining cross-sectional images in the image set according to the following formula: r is R ij =R 0j -D i ×|R 0j -R Lj i/D, where i denotes the number of cross-sectional images, j denotes the number of ablation boundary points on each cross-sectional image, i=0, 1 … … L, j=1, 2 … … n, R ij Representing a cross-sectional image F i The position parameter of the determined ablation boundary point is F, and the cross-sectional image of the bladder neck position is F i (i=0), the cross-sectional image at the tip or middle position of the prostate is F i (i=l), the position parameter of the first ablation boundary point is R 0j The position parameter of the second ablation boundary point is R Lj ，D i Is a cross-sectional image F i (i=1, 2 … … L-1) and cross-sectional image F 0 The distance between D is the cross-sectional image F 0 And cross-sectional image F L Distance between them.
14. The apparatus of claim 8, wherein the ablation range determination module combines an optimized ablation range for a predicted value of a tendency to collapse of the prostate based on the determined ablation range.
15. An electronic device, the electronic device comprising: a processor, a memory and a computer program stored on the memory and executable on the processor, the computer program being executed by the processor to perform the steps of the method of determining a conformal ablation range of a prostate as claimed in any one of claims 1-7.
16. A computer-readable storage medium, on which a computer program is stored, which computer program, when being executed by a processor, implements the steps of the method of determining a conformal ablation range of a prostate according to any one of claims 1-7.
17. A prostate conformal ablation surgical system, comprising: an ablation device, an imaging device, a surgical robotic device, further comprising the electronic device of claim 15 or the computer readable storage medium of claim 16.
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