model guided therapy and the role of dicom in surgery
Download
Skip this Video
Download Presentation
Model-Guided Therapy and the role of DICOM in Surgery

Loading in 2 Seconds...

play fullscreen
1 / 37

Model-Guided Therapy and the - PowerPoint PPT Presentation


  • 283 Views
  • Uploaded on

Model-Guided Therapy and the role of DICOM in Surgery . Heinz U. Lemke, PhD . Chair of Working Group 24 “DICOM in Surgery“. Content. Introduction (problems and solutions) Model guided therapy with TIMMS Classification and model classes Virtual human model examples

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Model-Guided Therapy and the ' - Solomon


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
model guided therapy and the role of dicom in surgery
Model-Guided Therapy and the role of DICOM in Surgery

Heinz U. Lemke, PhD

Chair of Working Group 24 “DICOM in Surgery“

content
Content
  • Introduction (problems and solutions)
  • Model guided therapy with TIMMS
  • Classification and model classes
  • Virtual human model examples
  • Conclusion
computer assisted digital or suite for endoscopic miss problems multiple data sources

Image Manager - Report

Video Endoscopy Monitor

C-Arm Images

MD’s

Staff

RN, Tech

EEG Monitoring

MRI Image - PACS

C-Arm Fluoroscopy

Left side of OR

Laser generator

EMG Monitoring

Image view boxes

Digital endoscopic OR suite facilitates MISS

Teleconferencing - telesurgery

Computer Assisted Digital OR Suite for Endoscopic MISSProblems: Multiple Data Sources

Courtesy of Dr. John Chiu

model guided therapy and the patient specific model
Model Guided Therapy and the Patient Specific Model
  • Model Guided Therapy (MGT) is a methodology complementing Image Guided Therapy (IGT) with additional vital patient-specific data.
  • It brings patient treatment closer to achieving a more precise diagnosis, a more accurate assessment of prognosis, as well as a more individualized planning, execution and validation of a specific therapy.
  • By definition, Model Guided Therapy is based on a Patient Specific Model (PSM) and allows for a patient specific intervention via an adapted therapeutic workflow.
model guided therapy and data structures
Model Guided Therapy and data structures
  • Model Guided Therapy based on patient specific modelling requires appropriate IT architectures and data structures for its realisation.
  • For PSMs, archetypes and templates allow different levels of generalisation and specialisation, respectively.
slide6

Mechatronics

(Navigation,

ablation, …)

EBM

Workflow

IHE

Omics

EMR

Data bases

(Atlas,

P2P repositories,

data grids, ...)

Model Based Patient Care

Modalities

(X-ray,CT, US,

MR,SPECT,

PET,OI)

Model Creation

and Diagnosis

(Data fusion,

CAD, …)

Model Maintenanceand Intervention

(Simulation,

decision support,

validation, …)

Biosensors

(physiology,

metabolism,

serum, tissue, …)

IT Communication Infrastructure

content7
Content
  • Introduction (problems and solutions)
  • Model guided therapy with TIMMS
  • Classification and model classes
  • Virtual human model examples
  • PM data structures (SDTM and OpenEHR)
  • Conclusion
slide8

Interventional Cockpit/SAS modules

Images

and

signals

Modelling

tools

Computing

tools

WF and

K+D

tools

Rep.

tools

Devices/

Mechatr.

tools

Validation

tools

WF`s, EBM,

”cases”

Models

(Simulated

Objects)

IT Model-Centric World View

Repo-

sitory

Engine

Data Exch.

Control

Therapy Imaging and Model Management System (TIMMS)

Modelling

Simulation

Kernel for

WF and K+D

Management

Visualisation

Rep. Manager

Intervention

Validation

IO Imaging

and

Biosensors

Therapy Imaging and Model Management System (TIMMS)

ICT infrastructure (based on DICOM-X) for data, image, model and tool communication for patient model-guided therapy

Models and

intervention

records

Data and

information

model guided therapy with timms
Model Guided Therapy with TIMMS
  • For a therapeutic intervention it is assumed that human, mechatronic, radiation or pharmaceutical agents interact with the model.
  • MGT provides the scientific basis for an accurate, transparent and reproducible intervention with the potential for validation and other services.
  • TIMMS is an IT meta architecture allowing for interoperability of the agents to facilitate a MGT intervention.
model guided therapy
Model Guided Therapy

The basic TIMMS patient model must have the following features:

  • The TIMMS patient model must have components which represent the patient as an n-dimensional and multiscale (in space and time) data set.
  • The TIMMS patient model must facilitate interfacing to the surgeon and other operative personnel, the TIMMS engines, TIMMS repositories, and the IT infrastructure.
  • The TIMMS patient model must be capable of linking these components, which may be static or dynamic, in a meaningful and accurate way.
  • For dynamic components, the TIMMS patient model must be able to process morphological and physiological data and perform the necessary mathematical functions to maintain the model in an up-to-date state.
model guided therapy11
Model Guided Therapy
  • The TIMMS patient model must be capable of being incorporated by the TIMMS executing workflow and responding to its changes.
  • The TIMMS patient model must be amenable to be developed using readily available, standardized informatics methodology. Tools may include UML, XML, Visio, block diagrams, workflow diagrams, MATLAB, Simulink, DICOM (including surgical DICOM), Physiome, CDISC SDTM, openEHRand similar products and tools.
  • The TIMMS patient model must comply to software engineering criteria, for example, to open standards and service-oriented architectures to allow for multi-disciplinary information exchange.
  • The TIMMS patient model must allow for further extensions to incorporate advances in molecular medical imaging, genomics, proteomics and epigenetics.
  • The TIMMS patient model must be amenable to be used for clinical trials, predictive modeling, personal health records and in the long term contribute to a Model Based Medical Evidence (EBME) methodology.
slide12

Interventional Cockpit/SAS modules

Images

and

signals

Modelling

tools

Computing

tools

WF and

K+D

tools

Rep.

tools

Devices/

Mechatr.

tools

Validation

tools

WF`s, EBM,

”cases”

Models

(Simulated

Objects)

IT Model-Centric World View

Repo-

sitory

Engine

Data Exch.

Control

Therapy Imaging and Model Management System (TIMMS)

Modelling

Simulation

Kernel for

WF and K+D

Management

Visualisation

Rep. Manager

Intervention

Validation

IO Imaging

and

Biosensors

Therapy Imaging and Model Management System (TIMMS)

ICT infrastructure (based on DICOM-X) for data, image, model and tool communication for patient model-guided therapy

Models and

intervention

records

Data and

information

generic and patient specific n d modelling tools
Generic and patient specific n-D modelling tools

Modelling

tools

  • Geometric modelling
  • Prosthesis modelling
  • Properties of cells and tissue
  • Segmentation and reconstruction
  • Biomechanics and damage
  • Tissue growth
  • Tissue shift
  • Properties of biomaterials
  • ...
model guided therapy14
Model Guided Therapy
  • MGT in its simpliest instantiation is an intervention with a subset, a single or a set of voxels representing locations within the patient body. With this view, it is an extension from Image (pixel) Guided Therapy (IGT) to model (voxel) guided therapy. Examples of model guided therapy are:

a) interventions within a subset of a voxel, e.g. cells, organelles, molecules, etc.

b) interventions with a voxel, e.g. small tissue parts of an organ or lesion, etc.

c) interventions with a set of voxels, e.g. part of functional structures of organs, organ components, soft tissue, lesions, etc.

model guided therapy15
Model Guided Therapy

In a simple PSM, voxels may be associated

with several dimensions of data

  • 1-D signals (e.g. EEG)
  • 2-D projection and tomographic images
  • 3-D reconstructions
  • Temporal change
  • Tissue/cell type
  • Ownership to organ, lesion, system, prothesis, chronic condition, etc.
  • Spatial occupancy/extension
  • Permeability (blood brain barrier)
  • Flow (e.g. electric, heat, liquid, perfusion, diffusion, etc.)
model guided therapy16
Model Guided Therapy

In a simple PSM, voxels may be associated

with several dimensions of data

  • Level of oxygenation (e.g. level of hypoxia)
  • Pharmacokinetics (e.g. effect of tissue on pharmaceutical agent, flow parameters, time to peak, etc.)
  • Pharmacodynamics (effect of pharmaceutical agent on tissue, ablation parameters)
  • Biological marker types (in vitro and/or in vivo molecular spectrum)
  • Reference coordinate system (e.g. Schaltenbrand/Warren, Talaraich/Tourneaux)
  • Value (life critical to life threatening)
  • Neighbourhood (e.g. 3³, 5³, 7³, etc.)
  • ...
example ent model elements
Example: ENT model elements

Source: G. Strauss

example ent model elements18
Example: ENT model elements

Source: G. Strauss

content19
Content
  • Introduction (problems and solutions)
  • Model guided therapy with TIMMS
  • Classification and model classes
  • Virtual human model examples
  • Conclusion
strategies for multiscale modelling
Strategies for multiscale modelling
  • Modelling is essential for understanding the knowledge of human characteristics such as, anatomy, physiology, metabolism, genomics, proteomics, pharmacokinetics, etc.
  • Because of the complexity of integrating the knowledge about the different characteristics the model of a human has to be realised on different levels (multiscale in space and time) and with different ontologies, depending on the questions posed and answered delivered.
  • The problems associated with using reduced-form components within large systems models stem primarily from their limited range of validity.
patient specific and associated modelling functions
Patient specific and associated modelling functions

In the Model-Centric World View a wide variety of information, relating to the patient, can be integrated with the images and their derivatives, providing a more comprehensive and robust view of the patient.

By default, the broader the spectrum of different types of interventional/surgical workflows which have to be considered, the more effort has to be given for designing appropriate multiscale PSM’s and associated services.

patient specific and associated modelling functions23
Patient specific and associated modelling functions

Management of n-D and multi resolutional knowledge (model of the biologic continuum in space and time) is still a research and development challenge.

If solved successfully, it will transform surgery into a more scientifically based activity.

content24
Content
  • Introduction (problems and solutions)
  • Model guided therapy with TIMMS
  • Classification and model classes
  • Virtual human model examples
  • Conclusion
slide25

Patient Specific CMB

Human Laser

Scan (CAESAR DB)

Multimodal Imaging(MRI, CT, Angio,..DT-MRI)

Visible Human

Anatomical Templateorgan surface meshes

Roberts JHU

Spitzer 2006 Virtual Anatomy

PKPD

FEM Mesh (Roberts JHU)

content26
Content
  • Introduction (problems and solutions)
  • Model guided therapy with TIMMS
  • Classification and model classes
  • Virtual human model examples
  • Conclusion
solutions and research focus medical
Solutions and Research Focus(medical)
  • Transition from image guided to model guided therapy (e.g. through workflow and use case selection/creation/repositories)
  • Concepts and specification of patient specific models in a multiscale domain of discourse
  • Concepts and design of a canonical set of low level surgical functions
  • Prototyping
slide28

Interventional Cockpit/SAS modules

Images

and

signals

Modelling

tools

Computing

tools

WF and

K+D

tools

Rep.

tools

Devices/

Mechatr.

tools

Validation

tools

WF`s, EBM,

”cases”

Models

(Simulated

Objects)

IT Model-Centric World View

Repo-

sitory

Engine

Data Exch.

Control

Therapy Imaging and Model Management System (TIMMS)

Prototyping

Modelling

Simulation

Kernel for

WF and K+D

Management

Visualisation

Rep. Manager

Intervention

Validation

IO Imaging

and

Biosensors

Therapy Imaging and Model Management System (TIMMS)

ICT infrastructure (based on DICOM-X) for data, image, model and tool communication for patient model-guided therapy

Models and

intervention

records

Data and

information

solutions and research focus technical
Solutions and Research Focus(technical)
  • Concepts and data structure design of patient specific models (e.g. with archetypes and templates)
  • Model management with open architectures (e.g. SOA)
  • SOA modulariation with repositories, engines, LLM´s and HLM´s
  • LLM´s as adaptive (cognitive/intelligent) agents
  • HLM´s as application modules (competitive differentiation)
  • LLM´s possibly as open source
  • Kernel (engine and repository) for adaptive workflow and K+D management
  • Cooperative and competitive R+D framework for engine and repository building
  • Therapy based open standard ( e.g. S-DICOM)
  • Transition from CAD to CAT modelling
slide30

Interventional Cockpit/SAS modules

Images

and

signals

Modelling

tools

Computing

tools

WF and

K+D

tools

Rep.

tools

Devices/

Mechatr.

tools

Validation

tools

WF`s, EBM,

”cases”

Models

(Simulated

Objects)

IT Model-Centric World View

Repo-

sitory

Engine

Data Exch.

Control

Therapy Imaging and Model Management System (TIMMS)

Archetypes and Templates

Modelling

Simulation

Kernel for

WF and K+D

Management

Visualisation

Rep. Manager

Intervention

Validation

IO Imaging

and

Biosensors

Therapy Imaging and Model Management System (TIMMS)

ICT infrastructure (based on DICOM-X) for data, image, model and tool communication for patient model-guided therapy

Models and

intervention

records

Data and

information

solutions and research focus medical and technical
Solutions and Research Focus(medical and technical)
  • Transition from image guided to model guided therapy (e.g. through workflow and use case selection/creation/repositories)
  • Use cases for adaptive workflow, exception handling and K+D management for selected interventions
  • Cooperative and competitive R+D framework for low (open source) and high level (competitive differentiation) surgical function computerisation
  • Information/model flow from diagnosis (e.g. CAD) to CAT (i.e. interdisciplinary cooperation)
  • Development of standards for patient modelling in WG24 “DICOM in Surgery”
slide32

Interventional Cockpit/SAS modules

Images

and

signals

Modelling

tools

Computing

tools

WF and

K+D

tools

Rep.

tools

Devices/

Mechatr.

tools

Validation

tools

WF`s, EBM,

”cases”

Models

(Simulated

Objects)

IT Model-Centric World View

Repo-

sitory

Engine

Data Exch.

Control

Candidate components for open source

Open Source

Modelling

Simulation

Kernel for

WF and K+D

Management

Visualisation

Rep. Manager

Intervention

Validation

IO Imaging

and

Biosensors

Therapy Imaging and Model Management System (TIMMS)

ICT infrastructure (based on DICOM-X) for data, image, model and tool communication for patient model-guided therapy

Models and

intervention

records

Data and

information

wg 24 dicom in surgery project groups
WG 24 “DICOM in Surgery“ Project Groups

PG1 WF/MI Neurosurgery

PG2 WF/MI ENT and CMF Surgery

PG3 WF/MI Orthopaedic Surgery

PG4 WF/MI Cardiovascular Surgery

PG5 WF/MI Thoraco-abdominal Surgery

PG6 WF/MI Interventional Radiology

PG7 WF/MI Anaesthesia

PG8 S-PACS Functions

PG9 WFMS Tools

PG10 Image Processing and Display

PG11 Ultrasound in Surgery

definition of surgical workflows s wfs
Definition of Surgical Workflows (S-WFs)

Micro Laryngeal Surgery (MLS) (PG2 ENT/CMF)

Foreign Body Excision (PG2 ENT/CMF)

Total Hip Replacement Surgery (PG3 Orthopaedic)

Total Endoscopic Coronary Artery Bypass (TECAB) (PG4 Cardiovascular)

Mitral Valve Reconstruction (MVR) (PG4 Cardiovascular)

Laparoscopic Splenectomy (PG5 Thoraco-abdominal)

Laparoscopic Cholecystectomy (PG5 Thoraco-abdominal)

Laparoscopic Nephrectomy left (PG5 Thoraco-abdominal)

Angiography with PTA and Stent (PG6 Interventional Radiology)

Hepatic Tumor Radio Frequency Ablation (PG6 Interventional Radiology)

Trajugular Intrahepatic Portosystemic Shunt (PG6 Interventional Radiology)

slide35

CARS 2008 Computer Assisted Radiology and Surgery

CARS / SPIE / EuroPACS 9th Joint Workshop onSurgical PACS and the Digital Operating RoomBarcelona, 28 June, 2008

12th Meeting of the

DICOM Working Group WG 24 “DICOM in Surgery“

Barcelona, 28 June 2008

http://www.cars-int.org

wg24 dicom in surgery
WG24 “DICOM in Surgery”

Secretariat: Howard Clark, NEMA

Secretary: Franziska Schweikert, CARS/CURAC Office [email protected]

General Chair: Heinz U. Lemke, ISCAS/CURAC, Germany

Co-Chair: Ferenc Jolesz, Harvard Medical School, Boston(Surgery/Radiology)

Co-Chair: tbd

(Industry)

ad