This thesis presents the first work, to our knowledge, to evaluate the potential of Optical Coherence Tomography (OCT) as an intravascular imaging modality to characterize and guide interventions on chronic total occlusions (CTOs) in arteries. An ex vivo imaging study using OCT is presented that characterizes various pathologies associated with peripheral CTOs and illustrates the ability to differentiate between the vessel wall and the occluded lumen. We also found that, while OCT could image approximately 1mm through tissue, it was effective for imaging deeper through clarified microchannels seen within the occluded lumen. While others had reported observing such microchannels within the lumen before, little was known about the global architecture of these channels. This motivated a study of the global morphology of microchannels in occlusions using micro computed tomography (microCT). In this microCT study, we found that microchannels within the occluded lumen of the artery appeared to be continuous over several millimeters. However, these channels also exited the artery frequently, suggesting the need for some form of imaging guidance. As a potential intravascular imaging set-up, a forward-viewing OCT catheter was built. This catheter uses a novel scanning mechanism that combines high voltage and a dissipative polymer to achieve fast compact actuation. Doppler OCT results are presented using this catheter to image flow in the forward direction. Doppler OCT imaging of microchannels in vivo is also shown in a surgically exposed occluded artery in situ.

Modern image-guided surgery aids minimally-invasive, high-precision procedures that increase efficacy of treatment. This thesis investigates two research aims to improve precision and integration of intraoperative cone-beam CT (CBCT) imaging in guidance of head and neck (H&N) surgery. First, marker configurations were examined to identify arrangements that minimize target registration error (TRE). Best arrangements minimized the distance between the configuration centroid and surgical target while maximizing marker separation. Configurations of few markers could minimized TRE with more markers providing improved uniformity. Second, an algorithm for automatic registration of image and world reference frames was pursued to streamline integration of CBCT with real-time tracking and provide automatic updates per scan. Markers visible to the tracking and imaging systems are automatically co-localized and registered with equivalent accuracy and superior reproducibility compared to conventional registration. Such work helps the implementation of CBCT in H&N surgery to maximize surgical precision and exploit intraoperative image guidance.

<p>To date, image localization of mobile tumors prior to radiation delivery has primarily been confined to 2D and 3D technologies, such as fluoroscopy and 3D cone-beam CT (3D-CBCT). Due to the limited information from these images, larger volumes of healthy tissue are often irradiated in order to ensure the radiation field encompasses the entirety of the target motion. Since the overarching goal of radiation therapy is to deliver maximum dose to cancerous cells and simultaneously minimize the radiation delivered to healthy surrounding tissues, it would be ideal to use 4D imaging to obtain time-resolved volume images of the tumor motion during respiration. </p><p>4D-CBCT imaging has been previously investigated, but has not yet seen large clinical translation due to the obstacles of long acquisition time and large image radiation dose. Furthermore, 4D-CBCT currently requires the use of external surrogates to correlate the patient's respiration with the image acquisition process. This correlation has been under question by a multitude of studies demonstrating the uncertainties that exist between the surrogate and the actual motion of the internal anatomy. Errors in the correlation process may result in image artifacts, which could potentially lead to reconstructions with inaccurate target volumes, thereby defeating the purpose of even using 4D-CBCT. </p><p>It is therefore the aim of this dissertation to initially highlight an additional limitation of using 3D-CBCT for imaging respiratory motion and thereby reiterate the need for 4D-CBCT imaging in the treatment room, develop a simple and efficient technique to achieve markerless, self-sorted 4D-CBCT and finally to comprehensively evaluate its robustness across a variety of potential clinical scenarios with a digital human phantom. </p><p>People often spend a longer period of time exhaling as compared with inhaling, and some do so in an extremely disproportionate manner. To demonstrate the disadvantage of using 3D-CBCT in such instances, a dynamic thorax phantom was imaged with a large variety of simulated and patient-derived respiratory traces of ratios of time spent in the inspiration phase versus time spent in the expiration phase (I/E ratio). Canny edge detection and contrast measures were employed to compare the internal target volumes (ITVs) generated per profile. The results revealed that an I/E ratio of less than one can lead to potential underestimation of the ITV with the severity increasing as the inspiration becomes more disproportionate to the expiration. This occurs because of the loss of contrast in the inspiration phase, due to the fewer number of projections acquired there. The measured contrast reduction was as high as 94% for small targets (0.5 cm) moving large amplitudes (2.0 cm) and still as much as 22.3% for large targets (3.0 cm) moving small amplitudes (0.5 cm). This is alarming because the degraded visibility of the target in the inspiration phase may inaccurately impact the alignment of the planning ITV with that of the FB-CBCT and thereby affect the accuracy of the localization and consequent radiation delivery. These potential errors can be avoided with the use of 4D-CBCT instead, to form the composite volume and serve as the verification ITV for alignment.</p><p>In order to delineate accurate target volumes from 4D-CBCT phase images, it is crucial that the projections be properly associated with the patient's respiration. Thus, in order to improve previously developed 4D-CBCT techniques, the basics of Fourier Transform (FT) theory were utilized to extract the respiratory signal directly from the acquired projection data. Markerless, self-sorted 4D-CBCT reconstruction was achieved by developing methods based on the phase and magnitude information of the Fourier Transform. Their performance was subsequently compared to the gold standard of visual identification of peak-inspiration projections. Slow-gantry acquired projections of two sets of physical phantom data with sinusoidal respiratory cycles of 3 and 6 seconds as well as three patients were used as initial evaluation of the feasibility of the Fourier technique. Quantitative criteria consisted of average difference in respiratory phase (ADRP) and percentage of projections assigned within 10% respiratory phase of the gold standard (PP10). For all five projection datasets, the results supported feasibility of both FT-Phase and FT-Magnitude methods with ADRP values less than 5.3% and PP10 values of 87.3% and above. </p><p>Because the technique proved to be promising in the initial feasibility study, a more comprehensive evaluation was necessary in order to assess the robustness of the technique across a larger set of possibilities that may be encountered in the clinic. A 4D digital XCAT phantom was used to generate an array of respiratory and anatomical variables that affect the performance of the technique. The respiratory variables studied included: inspiration to expiration ratio, respiratory cycle length, diaphragmatic motion amplitude, AP chest wall expansion amplitude, breathing irregularities such as baseline shift and inconsistent peak-inspiration amplitude, as well as six breathing profiles derived from cine-MRI images of three healthy volunteers and three lung cancer patients. The anatomical variables studied included: male and female patient size (physical dimension and adipose content), body-mass-index (BMI) category, tumor location, and percentage of the lung in the field-of-view (FOV) of the projection data. CBCT projections of each XCAT phantom were then generated. Additional external imaging factors such as image noise and detector wobble were added to select cases with different percentages of lung in the projection FOV to investigate any effects on the robustness. FT-Phase and FT-Magnitude were each applied and quantitatively compared to the gold standard. Both methods proved to be robust across the studied scenarios with ADRP<10% and PP10>90%, when incorporating minor modifications to region-of-interest (ROI) selection and/or low-frequency location to certain cases of diaphragm amplitude and lung percentage in the FOV of the projection (for which a method may have previously struggled). Nevertheless, in the instance where one method initially faltered, the other method prevailed and successfully identified peak-inspiration projections. This is promising because it suggests that the two methods provide complementary information to each other. To ensure appropriate clinical adaptation of markerless, self-sorted 4D-CBCT, perhaps an optimal integration of the two methods can be developed.</p> / Dissertation

Prostate cancer is the most common type of cancer afflicting Canadian men. Image-guided external radiation therapy of prostate cancer requires the accurate positioning of the patient in the treatment field. The alignment process is done using three fiducial markers implanted in the prostate. The current clinical practice involves the manual localization of these markers on pre-treatment, low-resolution electronic portal images (EPI). We propose an algorithm for the automatic detection of these markers. Our approach first enhances the quality of the EPI images using a fully automatic image enhancement approach. Next, fiducial markers are detected using template matching and a novel way of integrating information across multiple views. Experimental results show a significant improvement in the detection of fiducial markers in the left lateral view with respect to state-of-the-art results in related work. One should note that the left lateral view is the most challenging view due to the low resolution and the presence of occluding bony structures. / Graduate

Thesis (M. Sc.)--University of Canterbury, 2008. / Typescript (photocopy). "Year 2006-2008"--P. i. Includes bibliographical references (p. 122-123). Also available via the World Wide Web.

Ο σκοπός της διπλωματικής εργασίας ήταν η ανάπτυξη ενός μοντέλου Επαυξημένης Πραγματικότητας για την υποβοήθηση του χειρουργού-χειριστή ρομποτικού μηχανήματος. Το μοντέλο αυτό παρουσιάστηκε για την εύρεση του οπτικού πεδίου του ειδικού ενδοσκοπίου. Για τον σκοπό αυτό κατασκευάστηκαν δύο προγράμματα τα οποία μπορούν να χειριστούν ιατρικά δεδομένα και να προσφέρουν εικόνες από το εσωτερικό του μοντέλου του ασθενούς. Συγκεκριμένα, έγινε μελέτη των βασικών μεθόδων εφαρμογής Επαυξημένης Πραγματικότητας στην χειρουργική, όπως η εγγραφή του ασθενούς, η κατάτμηση των ιατρικών δεδομένων, η τρισδιάστατη ανακατασκευή τους και η ανίχνευση των ενδοσκοπικών εργαλείων και της κάμερας. Παρουσιάστηκε το πλήρες θεωρητικό μοντέλο εφαρμογής επαυξημένης πραγματικότητας και έγινε ανάλυση των επιμέρους διαδικασιών. Κατασκευάστηκαν με την βοήθεια της Matlab δύο προγράμματα με τα αντίστοιχα GUIs για τον προεγχειρητικό σχεδιασμό και την διεγχειρητική καθοδήγηση/επαύξηση αντίστοιχα. Τέλος έγινε δοκιμή των προγραμμάτων χρησιμοποιώντας 22 τομές μαγνητικής τομογραφίας (μορφής DICOM) εγκεφάλου με εμφανή καρκίνο στην αριστερή κοιλία. Επίσης καταγράφηκαν οι εικόνες και τα δεδομένα που παίρνουμε σε κάθε βήμα εφαρμογής των προγραμμάτων με στόχο την αξιολόγηση τους. Το μοντέλο αυτό κατασκευάστηκε με στόχο την εφαρμογή του σε επεμβάσεις μέσω του ρομποτικού μηχανήματος daVinci. Παρόλα αυτά η γενικότερη εφαρμογή της μεθοδολογίας που αναπτύσσεται μπορεί να βρει εφαρμογές και σε άλλες ενδοσκοπικές επεμβάσεις. / The purpose of this thesis was to develop a model of Augmented Reality to assist the surgeon-operator of a robotic machine. The model has been presented for finding the field of special endoscope. For this purpose we built two programs that can manipulate medical data and provide images of the interior of the patient’s model. Specifically, a study was done in the basic methods of Augmented Reality application in Surgery such as, the registration of the patient, the segmentation of medical data, their 3D reconstruction and the detection of endoscopic instruments and the camera. Has been presented the complete theoretical model for applying augmented reality and an analysis of individual procedures was done. Moreover we constructed with the help of Matlab two programs with their GUIs, for preoperative planning and intraoperative guidance/augmentation, respectively. Finally the programs were tested, using 22 MRI slices (format DICOM) with visible brain cancer in the left ventricle. Also were recorded images and data that we get at each step of programs implementation in order to evaluate them. This model was constructed to implement the operations through the daVinci robotic machine. Nevertheless, the general application of the methodology developed in this study may find applications also in other endoscopic procedures

Plasmon resonance associated with nanoparticles of gold can enable photothermal ablation of tissues or controlled drug release with exquisite temporal and spatial control. These technologies may support many applications of precision medicine. However, clinical implementations of these technologies will require new methods of intraoperative imaging and guidance. Near-infrared laser surgery is a prime example that relies on improved image guidance. Here we set forth applications of augmented microscopy in guiding surgical procedures employing plasmon resonant gold-coated liposomes. Absorption of near-infrared laser light is the first step in activation of various diagnostic and therapeutic functions of these novel functional nanoparticles. Therefore, we demonstrate examples of near-infrared visualization of the laser beam and gold-coated liposomes. The augmented microscope proves to be a promisingimage guidance platform for a range of image-guided medical procedures.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Endodontic treatment in teeth with pulp canal obliteration (PCO) is challenging. Guided Endodontic Access (GEA) combines information from a cone-beam computed tomography (CBCT) scan with an intra-oral scan to create a stent that can be used as a guide to treat teeth with PCO. GEA stents designed with traditional palatal accesses were shown to be successful in accurately negotiating these 3D printed teeth with simulated PCO, however, the difference in accuracy between the traditional palatal access compared to a conservative incisal access is not yet known. Objective: This in vitro study compares GEA stents designed with an incisal access approach to GEA stents designed with a traditional palatal access approach. The effect on the overall degree of deviation of the designed access path from the prepared path is evaluated by measuring the degree of angle of deviation and amount of deviation in millimeters. Materials and Methods: A 3-D printed maxillary model of an anonymous patient was used. PCO was simulated in a 3D printed natural #8 using the coDiagnostiX software tooth at two levels: coronal and mid-root. A GEA stent that extended from tooth #3 to tooth #14 with a guide sleeve over the simulated tooth #8 was accessed with a dedicated 1.0 mm diameter and 20 mm length drill that is designed to fit the access sleeve. 15 GEA stents had guides utilized for the incisal access approach, and 15 GEA stents had guides utilized for the traditional palatal access approach. Results: Angle, mesio-distal (base), and mesio-distal (tip) deviations were significantly lower for the incisal access compared to the traditional access. Inciso-apical (base) deviation was significantly more negative for incisal access compared to the traditional access. Bucco-lingual (base) deviation was significantly more negative for traditional access compared to the incisal access, while incisal and traditional accesses were not significantly different for bucco-lingual (tip) deviation. Coronal 1/3 calcification groups had significantly more mesio-distal (base) deviation than the middle 1/3 and no PCO groups. The no PCO group had significantly more negative inciso--apical (base) deviation than the coronal 1/3 calcification and middle 1/3 calcification groups, and the coronal 1/3 calcification group was significantly more negative than the middle 1/3 calcification group. The coronal 1/3 calcification group had significantly more mesio-distal (tip) deviation than the no PCO group. PCO level did not have a significant effect on angle, bucco-lingual (base), or bucco-lingual (tip) deviations. Conclusion: The utilization GEA via incisal access resulted in less degree and amount of drill deviation compared to the traditional access at all levels of calcification, however, the level of PCO did not influence the degree and amount of drill deviation between the incisal and traditional access approaches. It can be concluded that the use of a GEA stent that utilizes an incisal access approach in teeth with PCO will result in a more predictable outcome.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19225号 / 医博第4024号 / 新制||医||1010(附属図書館) / 32224 / 京都大学大学院医学研究科医学専攻 / (主査)教授 戸井 雅和, 教授 富樫 かおり, 教授 一山 智 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

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