© nih national center for image-guided therapy, march 2008 igt clinical workshop non-rigid,...
TRANSCRIPT
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
Non-Rigid, Multi-Modality Non-Rigid, Multi-Modality Image Registration Image Registration
for Thermal Ablation:for Thermal Ablation: Pre-Procedural MRI to Intra-
Procedural CT for Tumor Targeting
N. Archip, P.R. MorrisonBrigham & Women’s Hospital
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
WORKSHOP OBJECTIVE
To illustrate the need for image registration to address limitations in targeting a tumor during a tumor ablation procedure.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
ABLATION
MRI
CT
US
BONE/SOFT TISSUE
KIDNEY/ADRENAL
LIVER
LUNG
GUIDANCEMODALITY
ABLATIVEAGENT
TREATMENTSITE
Acad Radiol 2005;12:1100-109
CRYOTHERAPY
RFA
ETOH
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
• RFA: RADIOFREQUENCY ABLATION
• CRYO: CRYOTHERAPY
• LITT, ILT: LASER ABLATION
• MWA: MICROWAVE ABLATION
• HIFU, FUS: FOCUSED ULTRASOUND
THERMAL ABLATION
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
CLINICAL SYSTEMS
• RF generator & electrode• CRYO unit & probe • LASER & optical fiber • MW generator & antenna
PERCUTANEOUS ABLATION
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
CLINICAL ENIRONMENT
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
DEFINEPLANTARGETMONITORCONTROLASSESS
IMAGE-GUIDANCE
Radiology 2005; 236:716-724
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
• MRI-guided cryotherapy of a 3.4cm liver metastasis• Sagittal T2-weighted fse imaging used to place
cryoprobes (arrowheads) into the tumor (arrow)• Iceballs form around each probe; these coalesce• Tumor is eclipsed
DYNAMIC PROCESSES
Acad Radiol 2005;12:1100-109
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
3-D PROCESS
Pre
Intra
Post
Post in 3-D
Modified from AJR 2004;183:707–712
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
RFA Post-RFA MRI Coronal
CT-GUIDED RFA IN LUNG
TARGET
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
CE CT PRE CE MRI POSTCT INTRA
PLAN – TX - ASSESS
CT-GUIDED RFA IN SOFT TISSUE
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
Non-Rigid, Multi-Modality Non-Rigid, Multi-Modality Image Registration Image Registration
for Thermal Ablation:for Thermal Ablation: Pre-Procedural MRI to Intra-
Procedural CT for Tumor Targeting
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
CLINICAL NEED – Example 1
Recent BWH ablation case: Pre-Proc MRI vs Intra-CT47yo M, 3cm liver metastasis of sq cell ca in Seg 8; lung & vessels nearby
Pre-ProcedureCE MRI at 1.5T
Intra-ProcedureNon-Enhanced CT
Procedure 071107Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
CLINICAL NEED – Example 2
Recent BWH Ablation Case: PreProc MRI vs Intra-CT69yo M, 7cm liver metastasis of colon cancer; look for coverage; GB & colon nearby
Pre-ProcedureCE MRI at 1.5T
Intra-ProcedureNon-Enhanced CT
Procedure 080304Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
Dx comes from one imaging modality … Tx takes place under another.
CLINICAL NEED
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
SOLUTION: REGISTRATION
Bring Pre-procedural diagnostic MRI into the Intra-procedural
interventional space
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
PRE-PROCEDURAL CE MRI
051021 CEMRI PreTx Ser08 i270
Example:Registered Data
--MRI Pre
BWH Ablation Case50yo M, 2cm primary liver tumor (HCC) in segment 2
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop 051220 CT PreTx Ser04 i21
INTRA-PROCEDURAL CT
Example:Registered Data
--CT Intra
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
RFA ELECTRODE PLACED
Example:Registered Data
--CT Intra
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
REGISTERED IMAGES
Example:Registered Data
--Merged MRI & CT
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
WORK FLOW
Pre-Proc MRIIntra-Proc CT Registered CT & MRI
Images courtesy Cross-sectional Interventional Radiology, Brigham & Women’s Hospital, Boston, MA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
SLICER 3.0
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
WHAT IS 3D SLICER?
• A platform for exploring novel image analysis and visualization techniques
• A freely-downloadable program – Source code and
executables available for Windows, Linux, and Mac OS X
• Slicer is a research platform:– NOT an FDA approved
medical device – NOT finished – some parts
will work better than others
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
SLICER FEATURES
• Visualization • Filtering• Registration• Segmentation• DTI• Quantification• Real-time Integration
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
“SLICER 3”
• Next Generation of the 3D Slicer software• Beta Release in Jan
2007• Slicer 3.0 schedule
for June 2007• www.slicer.org
Image: S Pieper
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
WHAT IS SLICER 3?
• Total Rework of 3D Slicer
– At least 80% of code rewritten
– New versions of VTK (5.0), ITK (3.2)
– Improved Look and Feel (KWWidgets)
– Improved Modularity• Analysis routines can be used as
plugins or command line executables for batch processing
– Draws on Multi-Institution Community• Kitware, Inc., GE Research, Isomics,
Inc., BWH, UCLA, UCSD, UIowa, MIT, GaTech, UNC, U Utah, MGH, UCI, Harvard, WashU…
• NAC, NCIGT, NA-MIC, mBIRN, fBIRN
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
• Open Source, multi-platform
• Over 500k lines of code
• www.slicer.org
• Google: slicer 101
Images: A Golby, F Talos, P Black
SLICER 3
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
Image/Scene Management
• XML-Based MRML File Stores Scene Description– Volumes (Images,
Label Maps)– Models– Hierarchical Affine
Transforms– Scene Data (Cameras,
Colors, Fiducials, etc).• Manipulated in World
Coordinates based on Patient RAS
Image: S Pieper
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
OPENING SCREEN
The default display provides for primary 2D planes and a 3D Viewer space.Other display options can be selected.
screen_01
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
LOAD VOLUME FILE
screen_03
Having selected the Volumes Module …Images can be selected as DICOM or .nrrd files.
Here, a pre-procedural MRI scan of the liver is opened.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
VISUALIZE MRI DATA
screen_04
MRI opens in three orthogonal 2D planes.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
TUMOR LOCATION
screen_05
3D image planes can be viewed in the 3D space.
Can zoom, translate, rotate.
Here we locate tumor in all 3 planes (arrows)
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
3-D ONLY
screen_06 & 07
View MRI planes in 3D Viewer from above …
and from below.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
Add Volume CT
screen_08
Add a volume to the space …
Here, an intra-procedural CT dataset is opened.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
CT opens in three orthogonal 2D planes.
screen_09
VISUALIZE CT DATA
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
PREP FOR LINEAR TRANSFORM
screen_10
Initial alignment of MRI to CT is the Linear Transform 1 under Transform Module.
This manual transform is one of two options.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
Initial linear alignment solves initial displacement of MRI and CT.
Seen here in the 3D Viewer.
screen_20
LINEAR TRANSFORM
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop screen_22
PREP FOR AUTO TRANSFORM
Initial alignment of MRI to CT can be done by selecting Linear under Registration Module menu.
This automatic transform is the second of two options.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop screen_21c
RESULT OF RIGID REGISTRATION
Slider can be used to review the result of the linear alignment between the pre-procedural MRI and intra-procedural CT.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop screen_25
PREP FOR B-SPLINE REGISTRATION
Alignment can be done on the data using the Deformable B-Spline B-Spline Registration option.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop screen_26
RESULT OF B-SPLINE REGISTRATION
Slider can be used to review the result of the linear alignment between the pre-procedural MRI and intra-procedural CT.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop
CLINICAL SIGNIFICANCE
Image Registration has relevance for all aspects of an ablation procedure: Plan, Target, Monitor, Control, AssessThis is true for any image guidance modality.
© NIH National Center for Image-Guided Therapy, March 2008 IGT Clinical Workshop