Studies On The Application Of Medical Image Processing System In Liver Transplantation

BackgroundWith the development of computer science and information technology,The understanding of a complex biosystem and its disease has transferred from the qualitative judgment to precise quantification.It no longer depends on experience and feeling,but digital and visible methods,which can help us to find out the differences and changes of the complex system of life,and the changes of life phenomenon.That is the process of the digital medicine.In fact,The development of hepatic surgery and liver transplantation is the basic structure of the internal pipeline for the hepatic organ.,The traditional anatomical organs study is to aim directly at cadaveric specimens,however,it was not be perfusion,the internal pipe organ was collapse,the three-dimensional conformational space of the liver was changed,so the pipeline data which we obtained was different from the structure of the living liver.With the development of modern imaging(spiral CT,MRI,etc.),hepatobiliary surgery get to a new stage,the concept of surgical treatment of liver cancer is being transformed,many liver cancers which encroached the porta hepatis,portal vein and inferior vena cava were be exairesised; the living donor right liver,or the enlarged right liver transplantation was successful by surgery.Although,it is the king problem that the complexity and variability of liver and other organ pipe structure remain to cause the complications for example, postoperative bleeding.The study of medical image visualization and virtual reality technology maybe solved these problems.with the chiastopic fusion and the rapidly development of the computer skill,the image processing skill,the medicophysics and the medicine,the surgery diagnosis and therapy have great change.In these years,the computer-assisted operation system and the virtual operation system are the achievement of the rapid development of the information science applied in the medical region.The surgeon can make the operation more safe,more reliable and more fidelity by the advanced skill.The flying development in modern science and technology has built a concrete ground for the vital studies on the three-dimensional (3D) reconstruction of hepatic duct systems in recent years.The 3D reconstruction through hispeed CT angiography conducted by Raptopouls V,et al displayed the full views of portal and hepatic veins as well as the spatial conformational relations anatomically so that the portal and hepatic veins can be located and their diameters, obstructions and collateral circulation can be evaluated.Wigmore SJ et al reconstructed liver from the scanned images by helical CT and performed the virtual surgical incision of liver for the purse of assessing the risk of hepatic failure after hepatic incision and deciding the incision range.The three-dimension hepatic and the virtual surgery make use of such imagery sequence as CT and MRI,so as to display a three-dimensional model of the various structures of the hepatic,making the hiding human organ a visible "live" three-dimensional object,Namely visualization.The strengths include:1) being specifically located in certain space;2) Being observable in structure and being measurable and available in various data;3) Enhancing the advancement of anatomical liver.In various surgeries of virtue liver,the CT or MRI examination data of specific liver cancer patients could be employed for image fusion and updating.Hence the surgeons can use their computers to conduct surgical planning,to repetitively test the operational process.Such computerization exercise will help surgeons to optimize the planning,to ensure the surgery quality and safety, and to reduce the operation complications. Part 1.The Normal Digital Intra-abdominal Vascular AnatomyObjective1.To study the Characteristics of the Digital Intra-abdominal arterial and its application in the liver transplantation.2.To study the Characteristics of the Digital Intra-abdominal portal vein and its application in the liver transplantation.3.To study the Characteristics of the Digital Intra-abdominal hepatic vein and its application in the liver transplantation.Methods1.Materials:(1) PHILIPS BRILLIANCE 64-slice helical CT,Image process workstation;(2) binocular tube high pressure injector;(3)computer;(4) DICOM Viewer;(5) ACDSee(6) Medical image processing software;(7) FreeForm Modeling System and PHANTOM.2.Examiners:200 common health examination person,male:116,female:84,3.Collection of CT scan data:the examiners were accepted plain scan and enhanced scan on epigastrium by 64-slice helical CT,and the scan data was burned and stored from Mxview which is a image postprocessing workstation for PHILIPS BRILLIANCE 64-slice helical CT.4.data transformation:The data which be burned imported into personal computers,using DICOM viewer,the original data format translate into BMP format,and then the size,order of the pictures were adjusted by ACDSee.5.Image Segmentation:The CT data which was translated was imported into medical image processing software and made procedure segmentation and three-dimensional reconstruction,then stored the format for STL.6.smoothing:The models for the artery,portal vein and hepatic vein were imported into FreeForm Modeling System,and they were made smoothly.7.observation and typing:The models were observed through rotating,the characteristic of the models can be found,then typing for them.The typing methods of hepatic artery is accord to Hiatt,and portal vein according to Couinaud.Results1.digital eoeliae arteryThe 3D model of the celiac artery is clear,realistic,three dimensional sense, the main abdominal artery and its branches is shown very well.According to the typing of the hepatic artery by Hiatt,200 cases of hepatic artery be classified: typeⅠ:the normal anatomical structure,165 cases,account for 82.5%;typeⅡ: altemative or accessory left hepatic artery originate from left gastric artery,12 cases,account for 6%;typeⅢ:altemative,or accessory the right hepatic artery originate from superior mesenteric artery,17 cases,account for 8.5%;typeⅣ: double-alternative,left hepatic artery originate from left gastric artery,and right hepatic artery originate from superior mesenteric artery,1 case,account for 0.5%; typeⅤ:common hepatic artery originate from superior mesenteric artery,3 cases, account for 1.5%;typeⅥ:common hepatic artery originate from abdominal aorta,account for 1,account for 0.5%.In addition,we still found a special variation of Example 1:gastroduodenal artery and common hepatic artery origin from celiac artery.2.digital portal veinThe 3D model of the portal vein is clear,realistic,three dimensional sense. According to the typing of the portal artery by Couinaud,200 cases of portal artery be classified:normal type,portal vein trunk is diverged right branch and left one in the porta hepatis,167cases,accounting for 83.5%;Ⅰ-type variation, the portal vein trunk is diverged left branch,right anterior one and posterior one in the porta hepatis,23 cases,accounting for 11.5%;Ⅱ-type variation,the backbone of the portal vein after the first issue of the right branch and continue right up into the left branch and right anterior Branch,6cases,accounting for 3%;Ⅲ-type variation,the right branch of portal vein absence Example 1,accounting for 0.5%;Ⅳ-type variation,left branch of portal vein above the level of absence of two cases,accounting for 1%.In addition,1 case which is the special variation is found. 3.digital vena cavaThe 3D model of the vena cava is clear,realistic,three dimensional sense. According to the category which the hepatic veins enter inferior vena cava vein is different,four type hepatic veins are found:(1) left hepatic veins and venae hepatieae intermediate enter inferior vena cava vein together,and right hepatic veins enter inferior vena cava vein alone;(2)All the hepatic veins enter the inferior vena cava vein by themselves;(3)There are two branch venae hepaticae intermediate which enter the inferior vena cava vein;(4) There are two branch right hepatic veins,which enter inferior vena cava vein alone or together.Conclusions1.The digital artery,portal vein and hepatic vein is clear,realistic,three dimensional.The anatomic structure,course etc.is simulated the abdominal internal situation2.The variation of the hepatic artery and the portal vein is common.3.The digital artery,portal vein and hepatic vein have application in liver transportation.Part2.The digital liver,hepatoma and blood vessel,and the relationship for themObjective1.To study the feature of the digital liver and its application in the hepatic surgery.2.After the digital liver and blood vessel,to study the distribution of the portal vein,hepatic vein and hepatic artery in the liver.3.After the digital liver and blood vessel,to study the relationship of them, and their application in diagnosing the hepatoma,making the surgery program.4.To study the application of the digital liver,blood vessel and hepatoma in the abdominal surgery and clinical anatomy.Methods1.Materials:the same with part one. 2.Examiners:"health adult"1,2:they are volunteers who are no celiac disease; Case 1:it is diagnosed hepatoma in left lateral liver;Case 2:it is diagnosed hepatoma in left lateral liver r;Case 3:it is diagnosed hilar cholangiocarcinoma;Case 4:it is diagnosed hepatoma in right liver;Case 5: it is diagnosed hepatoma in sectionⅤ,Ⅵ;Case 6:it is diagnosed hepatoma in sectionⅦ,Ⅷ;Case 7:it is diagnosed diffuse hepatoma.3.Data acquisition,data transformation,procedure segment, reconstitution,smoothing is the same with part one.4.The way of the section for liver:the 3D model of the portal vein and the liver inport into FreeForm Modeling System,according to the portal vein branches at the course in the liver,divided into the sections of the liver.To distinguish them,which were coated with different color.5.Calculating the volume of the liver and the tumor:In the FreeForm Modeling System,shown the organ,clicking on the calculation of its size, the system calculate them automatically.Results1.Digital liverThe 3D model of the liver is clear,realistic and three-dimensional sense;To observing from the visceral surface and the diaphragmatic surface of the liver:all the anatomic landmark is very clearly.According to Glisson,the liver is divided into five leaf and eight paragraph(Couinaud approach).2.The distribution of Portal vein,hepatic vein,hepatic artery in intrahepatic paragraphs.Transparency of the liver,portal vein can be clearly displayed at all levels of intrahepatic branches of the paragraphs;transparency of the liver,the branch of portal vein,hepatic vein,hepatic artery in the intrahepatic paragraphs are showed very well.Simultaneously,the three group of the vessels are showed the relationship each other visually.3.the relationship among the liver,hepatoma and pipelineAfter 3D reconstruction of liver,hepatoma,pipeline,the relationship for them is showed clearly,such as the location of the tumor in the liver,the tumor whether encroach on blood vessels.4.liver and tumor volumeShown liver and tumor,using of FreeForm Modeling System for volume calculation function,the volume was calculated.Conclusions1.After digital liver,the anatomy of visceral surface and diaphragmatic surface is dearly,it is the same with the structure in human.The liver is divided into five leaf and eight paragraph.2.After digital liver and vessels,it is clear for the distribution and course of portal vein and hepatic veins in the liver,anatomical structure is true;3.After digital liver,hepatoma and vessels,the relationship for them is dear, which is valuable for guiding to preoperative diagnosis and evaluation in hepatoma;4.Digital liver and hepatoma provide a reference value in operatingevaluation.5.It is valuable for digital liver,abdominal blood vessels,and hepatoma in the abdominal surgery,clinical anatomy.Part3:Studies on the application of the visible simulation surgery in liver transplantationObjective1.To study the application of the visible simulation surgery in living donor liver transplantation.2.To study the application of the visible simulation surgery in piggyback liver transplantation.3.To study the application of the visible simulation surgery in orthotopic liver transplantation.4.To study the application of the visible simulation surgery which can be used to the pre-training,communication physician-patient relationship and spare-part surgery teaching in liver transplantation. Methods1.Materials:the same with part one.2.Examiners:the donor of living donor liver transplantation:the people who is health examination,CT prompting:the liver,gall,pancreas and spleen are normal;receptor:CT prompting:left lateral lobe of liver can be found one of the low-density 2×2cm video,others is not found focus of infection. clinical diagnosis:primary liver carcinoma,piggyback liver transplantation: the people who is health examination,CT prompting:the liver,gall, pancreas and spleen are normal;receptor:CT prompting:left lateral lobe of liver can be found one of the low-density video,others is not found focus of infection.,clinical diagnosis:primary liver carcinoma,orthotopic liver transplantation:the people who is health examination,CT prompting:the liver,gall,pancreas and spleen are normal;receptor:CT prompting:right lobe of liver can be found one of the low-density video,others is not found focus of infection.,clinical diagnosis:cholangiocellular carcinoma in right lateral of the liver.3.Data acquisition,data transformation,procedure segment, reconstitution,smoothing is the same with part one.4.Designed simulated surgery:the main step of living donor liver transplantation is the left lateral lobe of liver excision of the donor, hepatectomy of receptor,the donor implanting to the receptor;piggyback liver transplantation;the main step of piggyback liver transplantation is the liver excision of the donor,hepatectomy of receptor,the donor implanting to the receptor;the main step of orthotopic liver transplantation is the liver excision of the donor,hepatectomy of receptor,the donor implanting to the receptor.Results1.living donor liver transplantation1.1 The results of 64-slice spiral CT scan:a total of four scan donor layers are 462,4 receptor layer are 397 scan.The quality of receptor scanning periods are good.1.2 The results of 3D reconstruction:the abdominal 3D model of the procedures segment which is reconstructed is rapid.It is showed clear,realistic, three-dimensional sense that the abdominal 3D model is reconstructed.The abdominal organs and ducts can be simulated effective,and can be rotated random,magnifying,decreased and transparency.1.3 Simulation surgery:in FreeForm Modeling System and its own system of PHANTOM force-feedback,the environment of living donor liver transplantation were simulated,and using the secondary development of a simulation electric knives,simulation surgical needle and simulation tissue forceps in this equipment,the simulation surgery of the living donor liver transplantation can be operated.All the steps is in accordance with the process of clinical operations,and the cutting and saturation of the surgery has a strong sense of feedback.2.piggyback liver transplantation2.1 The results of 64-slice spiral CT scan:a total of four scan donor layers are 411,4 receptor layer are 406 scan.The quality of donor scanning periods are good.The contrast agent for the receptor of the left branch of portal vein is filled poor,others is good.2.2 The results of 3D reconstruction:It is showed clear,realistic, three-dimensional sense that the abdominal 3D model is reconstructed.The abdominal organs and ducts can be simulated effective,and can be rotated random,magnifying,decreased and transparency.2.3 Simulation surgery:in FreeForm Modeling System and its own system of PHANTOM force-feedback,the environment of piggyback liver transplantation were simulated,and using the secondary development of a simulation electric knives,simulation surgical needle and simulation tissue forceps in this equipment,the simulation surgery of the piggyback liver transplantation can be operated.All the steps is in accordance with the process of clinical operations,and the cutting and saturation of the surgery has a strong sense of feedback.3.Orthotopic liver transplantation3.1 The results of 64-slice spiral CT scan:a total of four scan donor layers are 503,4 receptor layer are 461 scan.The quality of donor scanning periods are good.The contrast agent for the receptor of the left branch of portal vein,hepatic artery and hepatic veins is filled poor,others is good.3.2 The results of 3D reconstruction:It is showed clear,realistic, three-dimensional sense that the abdominal 3D model is reconstructed.The abdominal organs and ducts can be simulated effective,and can be rotated random,magnifying,decreased and transparency.3.3 Simulation surgery:in FreeForm Modeling System and its own system of PHANTOM force-feedback,the environment of orthotopic liver transplantation were simulated,and using the secondary development of a simulation electric knives,simulation surgical needle and simulation tissue forceps in this equipment, the simulation surgery of the orthotopic liver transplantation can be operated.All the steps is in accordance with the process of clinical operations,and the cutting and saturation of the surgery has a strong sense of feedback.Conclusion1.The visible simulation surgery of liver transplantation can be guided clinical preoperative planning,formatting surgical programme etc.And a opportunity which is preoperative practice can be provided.2.The visible simulation surgery has a good application prospect on teaching of liver transplant surgery and physician-patient communication.