arXiv:2503.08802eess.IVcs.CV2025-03中稿 · MICCAI 2025被引 4

用可变形配准提升头颈肿瘤切除后切缘定位精度,结合AR实现术中精准导航。

Augmented Reality-based Guidance with Deformable Registration in Head and Neck Tumor Resection

  • 基于术前与术后表面信息融合,引入厚度信息改进可变形配准。
  • 在舌部标本上将配准误差降低33%,显著优于传统方法。
  • 集成AR自动对齐系统,帮助外科医生将切缘位置误差从9.8厘米降至4.8厘米。

头颈部鳞状细胞癌(HNSCC)是复发率最高的实体瘤之一,通过提高阳性切缘定位可降低复发风险。术中冰冻切片分析(FSA)是切缘评估的金标准,但由于复杂三维解剖结构及标本显著收缩,将冰冻切片结果准确映射回切除部位仍具挑战。本文提出一种新型可变形配准框架,同时利用术前标本上表面与术后切除部位信息,将厚度信息融入配准过程。该方法显著降低目标配准误差(TRE),在舌部标本中相比现有可变形配准方法提升达33%。舌部标本具有最复杂的三维形态且临床意义最高,不同标本表现出明显差异的形变行为,凸显需定制化形变策略。为辅助术中可视化,进一步将该框架与增强现实(AR)自动对齐系统集成,可自动将带阳性切缘标注的变形三维标本网格精准叠加于切除部位。一项包含两名外科医生的初步研究显示,集成系统使平均目标重定位误差由9.8厘米降至4.8厘米。

原文摘要 · Abstract (English)

Head and neck squamous cell carcinoma (HNSCC) has one of the highest rates of recurrence cases among solid malignancies. Recurrence rates can be reduced by improving positive margins localization. Frozen section analysis (FSA) of resected specimens is the gold standard for intraoperative margin assessment. However, because of the complex 3D anatomy and the significant shrinkage of resected specimens, accurate margin relocation from specimen back onto the resection site based on FSA results remains challenging. We propose a novel deformable registration framework that uses both the pre-resection upper surface and the post-resection site of the specimen to incorporate thickness information into the registration process. The proposed method significantly improves target registration error (TRE), demonstrating enhanced adaptability to thicker specimens. In tongue specimens, the proposed framework improved TRE by up to 33% as compared to prior deformable registration. Notably, tongue specimens exhibit complex 3D anatomies and hold the highest clinical significance compared to other head and neck specimens from the buccal and skin. We analyzed distinct deformation behaviors in different specimens, highlighting the need for tailored deformation strategies. To further aid intraoperative visualization, we also integrated this framework with an augmented reality-based auto-alignment system. The combined system can accurately and automatically overlay the deformed 3D specimen mesh with positive margin annotation onto the resection site. With a pilot study of the AR guided framework involving two surgeons, the integrated system improved the surgeons' average target relocation error from 9.8 cm to 4.8 cm.

医学影像可变形配准AR导航手术辅助

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