research activities at the - mimos.it fileresearch activities at the v. ferrari, a. pietrabissa, f....
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Research activities at the
V. Ferrari, A. Pietrabissa, F. Mosca
Simulazione e pianificazione della procedura chirurgica
le potenzialità della collaborazione tra medico e esperto CAS
Università di PisaDipartimento di Oncologia, dei Trapianti
e delle Nuove Tecnologie in Medicina
www.endocas.org
I I willwill speakspeak aboutabout
� Laboratory description
� How we:
� generate patient specific 3D virtual models
� manipulate patient specific 3D virtual models
� visualize patient specific 3D virtual models
for surgical planning and simulation
� Examples given from clinical pratice (abdominal surgery)
EndoCAS – University of Pisa - www.endocas.org - [email protected]
WhereWhere wewe areare
EndoCAS – University of Pisa - www.endocas.org - [email protected]
WeWe are are closeclose toto the the surgeonssurgeons……
� EndoCAS is located inside the Cisanello hospital structures, in close contact of the medical partners and the operating rooms.
� The Research team involves:
� Scientists
� Engineers
� Surgeons
� Radiologists
� Medical Staff
� Economists
300 mt
Department of General Surgery and Transplantation
EndoCAS Center
EndoCAS – University of Pisa - www.endocas.org - [email protected]
� EndoCAS is located inside the Cisanello hospital structures, in close contact of the medical partners and the operating rooms.
� The Research team involves:
� Scientists
� Engineers
� Surgeons
� Radiologists
� Medical Staff
� Economists
…… and to the radiologistsand to the radiologists
Department of Radiology
EndoCAS Center
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Current activitiesCurrent activities
� Surgical Navigators and Mixed Reality systems
� Robotic/mechatronicInstruments
� Simulation and Deformable Models
� Surgical Gesture Analysis: Evaluation, Recognition and Automation
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Few information for the planning
No surgical simulation
Diagnosis
Intervention
Image Acquisition
3D ‘Mental Reconstruction’for diagnosis and planning
CurrentCurrent useuse of of medicalmedical imagesimages in in surgerysurgery
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCAS – University of Pisa - www.endocas.org - [email protected]
New New toolstools forfor radiologistsradiologists and and surgeonssurgeons
� Diagnosis and surgical planning with patientspecific 3D model
SEGMENTATION and 3D SURFACESSEGMENTATION and 3D SURFACES
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Tools for specific districts:
� Mimics - Materialise (automatic, bones)
� Brain Atlas (automatic, atlas, brain)
� Mevis (liver, service, region growing with automaticparameters adjusting)
General purpose tools:
� ITK-Snap (general purpose, snake, free)
� 3D slicer (general purpose, multi-phase, free)
� Amira (general purpose, not free)
� Osiris (general purpose, free)
� Analyze (general purpose, not free)
AbdomenAbdomen SegmentationSegmentation: software : software toolstools
No full
autom
aticsolu
tions!
No specifi
cto
ols. N
o pro
cedures!
EndoCAS – University of Pisa - www.endocas.org - [email protected]
AbdomenAbdomen segmentationsegmentation withwith generalgeneral purposepurpose SWSW
Radiologist
“knows what to do “
Engineer
“knows how to do “
Some days of work
EndoCAS – University of Pisa - www.endocas.org - [email protected]
SegmentationSegmentation tooltool
Project funded by:
Studio e sviluppo di una suite applicativa per l’elaborazione di immagini mediche
volumetriche e generazione di modelli 3D dell’anatomia del paziente
Project title
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCASEndoCAS segmentationsegmentation pipeline pipeline forfor CTCT
� This procedure uses more than one phases as radiologists in their work.
� Initially it is segmented structures that are easy to extract, and they are removed from the dataset.
� Optimal extraction sequence.
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCASEndoCAS segmentationsegmentation pipeline: high pipeline: high levellevel
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCASEndoCAS segmentationsegmentation pipeline: pipeline: lowlow levellevel
EndoCAS Segmentation Pipeline
in ITK-SNAP 1.5:
3D on the fly visualization
FLTK
VTK
ITK
Import / Export Dicom
Export Mesh VTK & STL
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCASEndoCAS segmentationsegmentation pipeline: core pipeline: core algorithmalgorithm
� Region growing:
� Choose a number of seed regions.
� The regions grow following specific criteria.
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCASEndoCAS segmentationsegmentation pipeline: core pipeline: core algorithmalgorithm
� Neighborhood connected region growing:
� Few and friendly parameters to choose.
� Fast growing.
� Stop criteria: no more voxel to add.
� the avoiding of erroneous growing trough small vessels or channels created by devices artefacts.
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCASEndoCAS segmentationsegmentation pipeline: core pipeline: core algorithmalgorithm
+ seed
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCASEndoCAS segmentationsegmentation pipelinepipeline
� abdominal aorta, vena cava, portal vein, splenic vein, splenic aorta, ureters, kidneys, pancreas, spleen and bones in 30 min.
30 cases
� Liver models
EndoCAS – University of Pisa - www.endocas.org - [email protected]
SimulationSimulation forfor liverliver epatectomyepatectomy
EndoCAS – University of Pisa - www.endocas.org - [email protected]
LiverLiver segmentationsegmentation and and surgicalsurgical simulationsimulation
EndoCAS – University of Pisa - www.endocas.org - [email protected]
LiverLiver segmentationsegmentation and and surgicalsurgical simulationsimulation
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Pancreas Pancreas CancerCancer: : fromfrom diagnosisdiagnosis toto surgerysurgery
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Pancreas Pancreas CancerCancer: a : a diagnosticdiagnostic challengechallenge
� Tumors attack anatomical structures withdifferent surrounding levels
� Tumor has indefinite borders respect to healtypancreatic tissue
� No enhancement standard� it may be bothiper and ipo enhanced
EndoCAS – University of Pisa - www.endocas.org - [email protected]
DuctalDuctal AdenocarcinomaAdenocarcinoma SegmentationSegmentation
Manual refining of semi-automatic segmentation
Mazzeo S. et al., “Evaluation of vascular infiltration in resected patients for pancreatic cancer:
comparison among multidetector CT, intraoperative findings and histopathology”, Abdom Imaging,
vol 32, pp 737–742, 2007
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Managing segmented Data by modeling softwareManaging segmented Data by modeling software
Using a 3D modelling and animation package, such as Autodesk® Maya
Importing Segmented Data into Maya in STL format
Selection of the file format to import the segmented mesh
Opening the STL segmented mesh
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Managing segmented Data by modeling softwareManaging segmented Data by modeling software
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Rapid prototyping for clinical activitiesRapid prototyping for clinical activities
EndoCAS – University of Pisa - www.endocas.org - [email protected]
How we visualize patient specific 3D virtual models
EndoCAS – University of Pisa - www.endocas.org - [email protected]
TradictionalTradictional monitorsmonitors and and stereoscopicstereoscopic glassesglasses
� In our lab (workstations)
� In the surgical room (laptop)
� 3D display
EndoCAS – University of Pisa - www.endocas.org - [email protected]
MixedMixed RealityReality
EndoCAS – University of Pisa - www.endocas.org - [email protected]
EndoCAS – University of Pisa, Italy
MonoscopicMonoscopic mixedmixed--realityreality
� Analitycal adaptation of the virtual camera
� Calibration routines
� Troubles: frame stability and fixed camera configuration
Ferrari V, Megali G, Troia E, Pietrabissa, F. Mosca “A 3D mixed-reality system for stereoscopic visualization of medical dataset” In press on IEEE TBME
EndoCAS – University of Pisa, Italy
StereoscopicStereoscopic mixedmixed--realityreality
NavigationNavigation
EndoCAS – University of Pisa, Italy
Megali G at. al. "EndoCAS Navigator Platform: a common platform for computer and robotic
assistance in minimally invasive surgery". In The International Journal of Medical Robotics and Computer Assisted Surgery, 2008
ConclusionConclusion
� The market and the open source community offer very useful solutions
� Often surgeons plan interventions without volumetric visualization and simulation:
� Difficult access to images
� Lack of competences and time
� Its necessary the integration in the radiological and in the surgical departments of CAD/CAS professional figures having high technical background and high competences in medical and surgical procedures.
� It allows also to perform focused research
EndoCAS – University of Pisa - www.endocas.org - [email protected]
Thank you!