© nih national center for image-guided therapy, march 2008 igt clinical workshop non-rigid,...

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

WORKSHOP OBJECTIVE

To illustrate the need for image registration to address limitations in targeting a tumor during a tumor ablation procedure.

ABLATION

BONE/SOFT TISSUE

KIDNEY/ADRENAL

GUIDANCEMODALITY

ABLATIVEAGENT

TREATMENTSITE

Acad Radiol 2005;12:1100-109

CRYOTHERAPY

• 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

CLINICAL SYSTEMS

• RF generator & electrode• CRYO unit & probe • LASER & optical fiber • MW generator & antenna

PERCUTANEOUS ABLATION

CLINICAL ENIRONMENT

DEFINEPLANTARGETMONITORCONTROLASSESS

IMAGE-GUIDANCE

Radiology 2005; 236:716-724

• 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

3-D PROCESS

Post in 3-D

Modified from AJR 2004;183:707–712

RFA Post-RFA MRI Coronal

CT-GUIDED RFA IN LUNG

TARGET

CE CT PRE CE MRI POSTCT INTRA

PLAN – TX - ASSESS

CT-GUIDED RFA IN SOFT TISSUE

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

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

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

Dx comes from one imaging modality … Tx takes place under another.

CLINICAL NEED

SOLUTION: REGISTRATION

Bring Pre-procedural diagnostic MRI into the Intra-procedural

interventional space

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

INTRA-PROCEDURAL CT

--CT Intra

RFA ELECTRODE PLACED

--CT Intra

REGISTERED IMAGES

--Merged MRI & CT

WORK FLOW

Pre-Proc MRIIntra-Proc CT Registered CT & MRI

SLICER 3.0

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

SLICER FEATURES

• Visualization • Filtering• Registration• Segmentation• DTI• Quantification• Real-time Integration

“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

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

• Open Source, multi-platform

• Over 500k lines of code

• www.slicer.org

• Google: slicer 101

Images: A Golby, F Talos, P Black

SLICER 3

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

OPENING SCREEN

The default display provides for primary 2D planes and a 3D Viewer space.Other display options can be selected.

screen_01

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.

VISUALIZE MRI DATA

screen_04

MRI opens in three orthogonal 2D planes.

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)

3-D ONLY

screen_06 & 07

View MRI planes in 3D Viewer from above …

and from below.

Add Volume CT

screen_08

Add a volume to the space …

Here, an intra-procedural CT dataset is opened.

CT opens in three orthogonal 2D planes.

screen_09

VISUALIZE CT DATA

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.

Initial linear alignment solves initial displacement of MRI and CT.

Seen here in the 3D Viewer.

screen_20

LINEAR TRANSFORM

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.

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.

PREP FOR B-SPLINE REGISTRATION

Alignment can be done on the data using the Deformable B-Spline B-Spline Registration option.

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.

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 non-rigid,...

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