Image Guided Therapy Program

Clare Tempany, MD

The Image Guided Therapy Program (IGTP) is combining advances in imaging and therapeutic technology to develop minimally invasive surgical and interventional techniques. The program represents a multidisciplinary clinical and research effort and has developed several novel therapies.

The IGTP is supported by the Center for Innovative Minimally Invasive Therapy (CIMIT) which is funded by the Department of Defense (DOD).

The IGTP includes a number of research initiatives with various funding sources.

What is Image-Guided Therapy?

The use of medical imaging for guidance of therapy is not a new concept. Since the discovery of x-rays, various imaging methods have been used to localize normal anatomical structures and pathologic lesions, as well as to locate instruments. These images are fundamental in finding optimal access to the target of interventions and in defining trajectories for therapeutic instruments. All available imaging modalities have been exploited for localization, targeting, and monitoring of interventions.

Initially, x-ray systems were used in operating rooms, but now ultrasound (US) machines have become predominant. More recently, computed tomography (CT) and magnetic resonance imaging (MRI) systems have been brought into the operating room environment for intraoperative image-guidance. At the same time, with the advance of computerized image processing and visualization tools, image-guidance systems have been introduced for various surgical and radiation oncology applications. These systems make use of preoperatively acquired images to create anatomical models, which provide localization, targeting, and visualization of the three-dimensional (3D) anatomy. Using the models, one can calculate radiation doses and optimize trajectories for beams.

This radiation therapy planning is very similar to surgical planning. In both cases, the preoperative image-based 3D models are used for defining various access strategies and to simulate a planned treatment. The so-called navigational systems are one step closer to intraoperative guidance, because the preoperatively created 3D models are registered to the patient. This provides a link between the image-based coordinates and the actual surgical position, defined by an instrument's location in the surgical field.

The increasing acceptance and dissemination of minimally invasive procedures has resulted in the recognition of the feasibility of image-guided approaches. Although interventional radiology has combined imaging with various novel therapeutic methods, the full utilization of advanced imaging technology has not yet been accomplished. Progress in computer technology has accelerated the development of image-processing algorithms, interactive visualization, and display methods, and has revitalized the field of image-guided therapy. The current tendency is the evolution of integrated therapy delivery systems in which advanced imaging modalities are closely linked with high-tech therapy devices and/or surgical systems.

Surgery today relies conceptually on the same principles as it did three thousand years ago: the surgeons use their hands directly to control instruments, and they use their eyes to provide them with feedback about the effect of their manipulations. Accordingly, a surgeon needs both visual and mechanical access to the site of an operation. The modern trend in surgery, however, is toward minimally invasive approaches, where the damage set for accessing the surgical site is reduced by using rigid or flexible long-necked instruments introduced through natural openings or small incisions into the target areas. These instruments typically carry some form of visualization equipment and some way to introduce instruments for procedures. Advanced imaging technology could expand the successful application of such endoscopic surgery, and at the same time improve planning and outcomes for traditional, open surgery.

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