Research activities at the - mimos.it fileResearch activities at the V. Ferrari, A. Pietrabissa, F....

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 - vincenzo.ferrari@endocas.org

WhereWhere wewe areare

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 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

Current activitiesCurrent activities

� Surgical Navigators and Mixed Reality systems

� Robotic/mechatronicInstruments

� Simulation and Deformable Models

� Surgical Gesture Analysis: Evaluation, Recognition and Automation

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

New New toolstools forfor radiologistsradiologists and and surgeonssurgeons

� Diagnosis and surgical planning with patientspecific 3D model

SEGMENTATION and 3D SURFACESSEGMENTATION and 3D SURFACES

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

aticsolu

tions!

No specifi

ols. N

cedures!

AbdomenAbdomen segmentationsegmentation withwith generalgeneral purposepurpose SWSW

Radiologist

“knows what to do “

Engineer

“knows how to do “

Some days of work

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

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.

EndoCASEndoCAS segmentationsegmentation pipeline: high pipeline: high levellevel

EndoCASEndoCAS segmentationsegmentation pipeline: pipeline: lowlow levellevel

EndoCAS Segmentation Pipeline

in ITK-SNAP 1.5:

3D on the fly visualization

Import / Export Dicom

Export Mesh VTK & STL

EndoCASEndoCAS segmentationsegmentation pipeline: core pipeline: core algorithmalgorithm

� Region growing:

� Choose a number of seed regions.

� The regions grow following specific criteria.

� 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.

+ seed

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

SimulationSimulation forfor liverliver epatectomyepatectomy

LiverLiver segmentationsegmentation and and surgicalsurgical simulationsimulation

Pancreas Pancreas CancerCancer: : fromfrom diagnosisdiagnosis toto surgerysurgery

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

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

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

Managing segmented Data by modeling softwareManaging segmented Data by modeling software

Rapid prototyping for clinical activitiesRapid prototyping for clinical activities

How we visualize patient specific 3D virtual models

TradictionalTradictional monitorsmonitors and and stereoscopicstereoscopic glassesglasses

� In our lab (workstations)

� In the surgical room (laptop)

� 3D display

MixedMixed RealityReality

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

StereoscopicStereoscopic mixedmixed--realityreality

NavigationNavigation

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

Thank you!

Research activities at the - mimos.it fileResearch activities at the V. Ferrari, A. Pietrabissa, F....

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