Navigation tools for Image Guided Minimally invasive Therapies

图像引导微创治疗的导航工具

• 批准号: 7733647
• 负责人: Bradford Wood
• 金额: $ 2.5万
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7733647
• 关键词: Ablation; Address; Adoption; Adverse effects; Anatomy; Angiogenesis Inhibitors; Angioplasty; Area; Atherosclerosis; Attention; Automation; Beds; Biopsy; Brain Aneurysms; Caring; Catheters; Chemoembolization; Clinic; Clinical; Clinical Research; Clinical Treatment; Data; Development; Devices; Diagnosis; Diagnostic radiologic examination; Disease; Dose; Drug Delivery Systems; Electromagnetics; Endoscopes; Engineering; Feedback; Fluoroscopy; Focused Ultrasound Therapy; Future; Goals; Image; Imagery; Imaging Device; Immunotherapy; Institutes; Intervention; Interventional radiology; Intramural Research Program; Invasive; Laboratories; Laboratory Research; Liposomes; Localized; Magnetic Resonance Imaging; Malignant Neoplasms; Medical; Medical Device; Medicine; Metabolic; Methods; Miniaturization; Mission; Modality; Modeling; Molecular; Molecular Target; Monitor; Multimodal Imaging; Navigation System; Needles; Normal tissue morphology; Operating Rooms; Operative Surgical Procedures; Optics; Outcome; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Positron-Emission Tomography; Procedures; Process; Property; Radiofrequency Interstitial Ablation; Radionuclide Imaging; Research; Research Personnel; Research Project Grants; Research Training; Resolution; Resources; Robotics; Route; Sampling; Solid Neoplasm; Stents; System; Systemic disease; Techniques; Technology; Temperature; Testing; Therapeutic; Therapeutic Agents; Therapeutic Embolization; Thermal Ablation Therapy; Time; Tissues; Toxic effect; Training Programs; Translating; Translational Research; Ultrasonography; United States National Institutes of Health; Uterine Fibroids; Vision; anti-cancer therapeutic; anticancer treatment; base; bench to bedside; cancer therapy; clinically relevant; cost; design; drug discovery; image guided intervention; image guided therapy; improved; instrumentation; interest; microwave electromagnetic radiation; multidisciplinary; new technology; novel; oncology; programs; radiofrequency; scalpel; tool; treatment planning; tumor; validation studies; vector

Research in the Interventional Radiology (IR) lab is motivated by the fact that image guidance and minimally invasive approaches have revolutionized the management of many common diseases. However, diagnosis and therapy remain distinctly separated from each other in both time and space. We believe that this gap between diagnosis and therapy can be narrowed by minimally invasive image guided therapies and with the application of novel guidance technologies and engineered vectors. All research efforts in the IR lab are developed with a clear translational route to the clinic and address areas of urgent clinical need. The IR labs research program is separated into three main areas: electromagnetic (EM) and optical tracking and robotics, drug + device combinations, novel methods of augmentation of ablative energies (RFA or HIFU). The diversity of these projects requires an interdisciplinary team of researchers and takes full advantage of the interdisciplinary resources found within the Clinical Center and the Intramural Research Program of the National Institutes of Health. We believe that combining the imaging tools inherent to interventional radiology with pharmaceuticals and medical devices can make a significant contribution to the future treatment of both localized and systemic diseases, with an emphasis upon cancer therapeutics. Principal projects are: 1) Smart biopsy, 2) OR of the future and, 3) Drugs + devices. Smart biopsy relies upon precise electromagnetic tracking to target tissue to correlate sample with imaging parameters. OR of the future is a broad translational project that integrates a variety of technologies for navigation, automation, and visualization of medical procedures. Sub-projects within the Drug + Device model include: 1) Temperature sensitive liposomes combined with radiofrequency ablation (RFA) or high intensity focused ultrasound (HIFU), 2) Radiofrequency ablation combined with antiangiogenic therapy, and 3) Development of image-able drug eluting beads (DEB) for transcatheter arterial chemoembolization (TACE). The clinical treatment of solid tumors could be improved by controlling the pharmacologic properties of anticancer therapeutics to deliver a greater dose to the tumor; with conventional drugs, this dose is typically limited by toxic side effects in normal tissues. Therefore, the efficacy of current anticancer treatments may be improved with advances in drug delivery technologies that have received increased attention in recent years. The goal of drug delivery in the treatment of cancer is to increase the concentration of a therapeutic agent in the tumor while limiting systemic exposure and subsequent normal tissue toxicity. The combination of drug delivery technologies with image guided interventions represents a rich field with great translational potential and the ability to bridge the gap between diagnosis and therapy. Diagnosis and therapy remain distinctly separated from each other in time and space. The gap between diagnosis and therapy can be closed by minimally invasive image guided therapies. Real-time, intra-procedural tools will blend diagnosis and therapy into a dynamic, iterative process with improved outcomes. The redefining of surgical-like procedures will be fueled by multi-modality imaging, navigation, visualization, robotics, and automated precision tools. These enabling technologies have not yet been optimally applied to existing clinical problems, especially in minimally-invasive image guided therapies. This presents an opportunity to integrate these technologies into the clinical setting in a validated and cost-effective manner, and to study the impact prior to broad implementation. Image guidance and multimodality navigation will fuel a small revolution in procedural medicine, which presents unprecedented opportunity and challenge. Image guidance and minimally invasive approaches have revolutionized the management of many common diseases. The miniaturization of surgical interventions has seen the broad adoption of needle or catheter-based procedures such as tumor embolization, brain aneurysm coiling, aortic stent grafting, uterine fibroid embolization, atherosclerosis stenting and angioplasty, and tumor thermal ablation with radiofrequency. As procedures are becoming less and less invasive, they are more and more targeted and guided by imaging and spatial information. The ability to navigate a medical device to a target based upon multiple windows or multiple modalities should have tremendous advantages in certain settings. The combination of functional and morphologic (metabolic and anatomic) information on the same coordinate system is empowering. With multiple public and private partners, we have developed a multimodality interventional radiology suite that uses a CT coordinate frame to co-register different devices including pre-procedural images, intra-procedural ultrasound, gamma scintigraphy, CT, rotational fluoroscopy, robotics, electromagnetic tracking and therapeutic ultrasound, microwave, radiofrequency, etc. to allow the best combinations of techniques and guidance methods tailored to the particular patients needs. Combining imaging modalities can take advantage of each modality's strength. Real-time feedback and temporal resolution of ultrasound can be combined with the functional and metabolic data from PET and the spatial resolution of MR or CT, all on one seamless platform for treatment planning, targeting, procedural navigation, monitoring, and verification of treatment.

介入放射学（IR）实验室中的研究是由于图像指导和微创方法彻底改变了许多常见疾病的管理。 但是，在时间和空间中，诊断和治疗在彼此之间保持明显分离。 我们认为，诊断和治疗之间的这种差距可以通过微创图像指导疗法以及新颖的指导技术和工程载体的应用来缩小。 IR实验室中的所有研究工作均以通往诊所的清晰转换途径开发，并解决紧急临床需求的领域。 IR实验室研究计划分为三个主要领域：电磁（EM）和光学跟踪和机器人技术，药物 +设备组合，增强消融能量的新方法（RFA或HIFU）。 这些项目的多样性需要一个跨学科的研究人员团队，并充分利用了临床中心内发现的跨学科资源以及美国国立卫生研究院的壁内研究计划。 我们认为，将介入放射学固有的成像工具与药品和医疗设备相结合可以为对局部疾病和全身性疾病的未来治疗做出重大贡献，并重点是癌症治疗剂。 主要项目是：1）智能活检，2）或未来以及3）药物 +设备。智能活检依靠精确的电磁跟踪来靶组织将样品与成像参数相关联。或未来是一个广泛的转化项目，该项目集成了各种用于导航，自动化和可视化医疗程序的技术。 Sub-projects within the Drug + Device model include: 1) Temperature sensitive liposomes combined with radiofrequency ablation (RFA) or high intensity focused ultrasound (HIFU), 2) Radiofrequency ablation combined with antiangiogenic therapy, and 3) Development of image-able drug eluting beads (DEB) for transcatheter arterial chemoembolization (TACE).可以通过控制抗癌治疗剂的药理特性来改善实体瘤的临床治疗，从而为肿瘤提供更大的剂量。使用常规药物，这种剂量通常受正常组织中有毒副作用的限制。 因此，随着药物输送技术的进步，当前抗癌治疗的功效可能会提高，这些技术近年来受到了越来越多的关注。 癌症治疗药物的目的是增加肿瘤中治疗剂的浓度，同时限制全身暴露和随后的正常组织毒性。 药物输送技术与图像指导的干预措施的结合代表了一个丰富的领域，具有巨大的翻译潜力以及弥合诊断和治疗之间差距的能力。 诊断和治疗在时间和空间上仍然明显地彼此分离。诊断和治疗之间的差距可以通过微创图像指导疗法来缩小。实时的，手术内工具将诊断和治疗融合到动态的迭代过程中，并改善预后。多模式成像，导航，可视化，机器人技术和自动化精度工具的重新定义将促进类似外科手术的过程。这些促成技术尚未最佳地应用于现有的临床问题，尤其是在微创图像指导疗法中。这为将这些技术集成到临床环境中以经过验证且具有成本效益的方式，并在广泛实施之前研究影响。 图像指导和多模式导航将推动程序医学的一场小革命，这给出了前所未有的机会和挑战。图像指导和微创方法彻底改变了许多常见疾病的管理。手术干预措施的微型化已经看到了针或基于导管的程序，例如肿瘤栓塞，脑动脉瘤围绕，主动脉支架支架移植，子宫肌瘤栓塞，动脉粥样硬化置置和血管置换术以及血管性置换术以及具有放射性射流的肿瘤热水液。 随着程序变得越来越少，它们越来越有针对性的成像和空间信息来指导和指导。根据多个窗口或多种模式将医疗设备导航到目标的能力在某些设置中具有巨大的优势。在同一坐标系上的功能和形态学（代谢和解剖学）信息的组合正在增强。 With multiple public and private partners, we have developed a multimodality interventional radiology suite that uses a CT coordinate frame to co-register different devices including pre-procedural images, intra-procedural ultrasound, gamma scintigraphy, CT, rotational fluoroscopy, robotics, electromagnetic tracking and therapeutic ultrasound, microwave, radiofrequency, etc. to allow the best combinations of针对特定患者需求的技术和指导方法。结合成像方式可以利用每种方式的力量。超声的实时反馈和时间分辨率可以与PET的功能和代谢数据以及MR或CT的空间分辨率结合使用，所有这些都可以在一个无缝平台上用于治疗计划，靶向计划，程序性导航，监测和治疗验证。