| Purpose:(1)To establish a multi-modal image fusion navigation real-time guided particle implantation system;(2)To verify the accuracy of multi-modal image fusion navigation real-time guided particle implantation system;(3)To study the effectiveness and feasibility of multi-modal image fusion navigation real-time guided particle implantation system.Materials and Methods:1.Establishment of multi-modal image fusion navigation real-time guided particle implantation system.The system consists of hardware and software.The hardware mainly includes NDI(Northern Digital Technologies Inc.,NDI)magnetic positioning navigation system,magnetic positioning needle,computer displays and the bracket,ultrasound instrument;the software mainly includes program algorithm for calculating radioactive particle dose,ROI extraction,outline and segmentation program algorithm,three-dimensional reconstruction program algorithm,real-time imaging program algorithm and show of navigation system interface.The hardware and software parts are integrated and fused to establish a navigation method which integrates hardware and software systems,and can achieve real-time intraoperative navigation.2.Accuracy verification of puncture guided by multi-modal image fusion navigation real-time guided particle implantation system.2.1 Instruments,equipment and appliances:multi-modal image fusion navigation real-time guided particle implantation system,conventional 18G puncture(Percutaneous Transhepatic Cholangiography,PTC)needle,computed tomography(CT).2.2 Material:Self-developed agar phantom,built-in 5-10 ceramic beads as puncture targets.2.3 Method and operation steps:(1)The agar phantom was scanned by computed tomography(CT)and the original image data was obtained.(2)The original image data were imported into the multi-modal image fusion navigation real-time guided particle implantation system.Three-dimensional images were reconstructed by built-in algorithm in the system.The ultrasound and CT images were fused and registered.(3)The experimental group:guided by the multi-modal image fusion navigation real-time guided particle implantation system,the targets of agar phantom were punctured by magnetic positioning puncture;after puncture,the position of puncture needle was fixed,then the agar phantom was scanned by thin-slice CT and the original image data was obtained;the original data was imported into the multi-modal image fusion navigation real-time guided particle implantation system.The distance between the needle tip of the puncture needle and the center of the puncture target of the agar phantom was measured in three-dimensional space,and the puncture error was obtained and recorded.(4)Control group:Under the guidance of conventional ultrasound,18 G PTC puncture needle was used to puncture agar phantom target,the rest of which was the same as experimental group.(5)20 groups of experiments were carried out in the experimental group and the control group,and the puncture accuracy between the two groups was compared.2.4 Statistical methods:The statistical software was SPSS 23.0.The standard deviation of puncture error in the experimental group was calculated,and the paired t test was used to compare the puncture error between the two groups.3.The study of effectiveness and feasibility of the multi-modal image fusion navigation real-time guided particle implantation system.3.1 Instruments and equipment:multi-modal image fusion navigation real-time guided particle implantation system,conventional 18G puncture needle(PTC),computed tomography(CT).3.2 Material:Self-developed agar phantom,built-in three resin spheres into the phantom as the target lesions for implantation.The diameters were 2 cm,3 cm and 4 cm,respectively.3.3 Methods and procedures:(1)The agar phantom was scanned by computed tomography(CT)and the original image data were obtained.(2)Preoperative planning:The original image data were imported into the Treatment Planning System(TPS),and the target lesions in agar phantom were delineated,segmented and planned for particle implantation.(3)The result of particle implantation planning was imported into the multi-modal image fusion navigation real-time guided particle implantation system.The system used built-in algorithm to reconstruct three-dimensional images,and ultrasound and CT images were fused and registered.(4)Intraoperative guidance:The experimental group was guided by the multi-modal image fusion navigation real-time guided particle implantation system,and the control group was guided by two-dimensional ultrasound,using conventional 18-G PTC needle for particle implantation.The experiments were carried out for 20 times both in the experimental group and the control group.(5)Postoperative verification:After the implantation of the particles,the agar phantom was scanned again and the original image data was obtained.Target lesions,the actual spatial position of implanted particles and dose field were displayed in three-dimensional space by TPS system,and the spatial distribution of particles and dose field distribution were verified.3.4 Evaluation indicators:(1)The observation of the spatial location and uniformity of particles in the target lesions in the two groups.(2)The comparison of the difference of D90,D100 and V100 planned before implantation and D90,D100 and V100 verified after implantation in the two groups,which were AD90,AD100 and AV100.3.5 Statistical methods:The statistical software was SPSS 23.0.The paired t test was used to compare the experimental data between the two groups.Results:1.The error of puncture guided by the multi-modal image fusion navigation real-time guided particle implantation system was 0.912±0.27mm,which was significantly smaller than that guided by conventional two-dimensional ultrasound(2.124±0.41mm),and the difference between the two systems had significant statistical significance(p<0.01).2.The study of effectiveness and feasibility of the multi-modal image fusion navigation real-time guided particle implantation system.(1)Under the guidance of multi-modal image fusion navigation real-time guided particle implantation system,the particle distribution in agar phantom target is more uniform and closer to preoperative planning.(2)In target lesions of different sizes,the values of AD90,AD100 and AV100 before and after implantation of radioactive particles in agar phantom target lesions guided by the multi-modal image fusion navigation real-time guided particle implantation system were significantly lower than those of the control group guided by conventional two-dimensional ultrasound.(2.1)For the target lesion diameter of 2cm subgroup,△D90,△D100 and △V100 in the guidance group of the multi-modal image fusion navigation real-time guided particle implantation system were 2.70±0.88,2.07±0.74 and 1.93±0.44,respectively;in the conventional two-dimensional ultrasound guidance group,AD90,AD 100 and△V100 were 7.00±0.92,6.76±0.80,8.50±0.89,with statistical difference between the two groups(p<0.01,0.01,0.01).(2.2)For the target lesion diameter of 3cm subgroup,△D90,△D100 and △V100 in the guidance group of the multi-modal image fusion navigation real-time guided particle implantation system were 4.5±0.70,3.53±0.87 and 2.03±0.44,respectively;in the conventional two-dimensional ultrasound guidance group,△D90,△D100 and△V100 were 15.08±1.90,11.37±1.29,11.95±1.58,respectively,with statistical difference between the two groups(p<0.01,0.01,0.01).(2.3)For the 4cm subgroup of target lesion diameter,the guided group of real-time guided particle implantation system with multi-modal image fusion navigation△D90,△D100 and △100 were 6.24±0.63,3.53±0.87 and 2.18±0.53,respectively;the guided group of conventional two-dimensional ultrasound △D90,△D100 and △V100 were 14.73±2.06,14.85±1.54 and 14±1.47,respectively,with statistical difference between the two groups(p<0.01,0.01,0.01).Conclusion:1.The self-developed agar phantom has uniform and clean background,high definition,and strong contrast with target lesions.The lesions can be clearly displayed under ultrasound and CT images,and the puncture compliance is good.2.Multi-modal image fusion navigation real-time guided particle implantation system has high puncture accuracy and meets the puncture requirements.3.The multi-modal image fusion navigation real-time guided particle implantation system established in this study can achieve precise implantation of radioactive particles.The errors between the spatial distribution and dose field distribution of implanted particles and the preoperative planned particle distribution and dose field distribution are small,and its accuracy is significantly higher than that under the guidance of conventional two-dimensional ultrasound.At the level of 2 cm,3 cm and 4 cm in diameter of the lesion,this advantage exists in the navigation system. |
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