1. Brigham and Women’s Hospital Image Guided Therapy Program

2. Successes and Challenges in Effectors and Scanner Control Nobuhiko Hata, PhD Brigham and Women’s Hospital

3. Brigham and Women’s Hospital Image Guided Therapy Program Issues Basic functions for Image Guided Therapy (visualization, image I/O, patient-to-image registration) are relatively easy to implement (thanks to VTK and ITK) Challenge 1: Develop and apply new medical image processing methods to enable new therapy options Challenge 2: Provide meeting point for robotics, medical image processing, and bio-physics

4. Brigham and Women’s Hospital Image Guided Therapy Program Objective Open source software 3D Slicer Modular architecture for multiple IGT applications Integration to FDA-approved commercial systems Issues

5. Brigham and Women’s Hospital Image Guided Therapy Program Slicer 1996: Carl-Fredrick Westin (newly hired post- doc) and Noby Hata (SPL grad student) developed prototype using VTK-beta 1997: First MR-guided neurosurgery Dave Gering (MIT grad student) re-design the software Lauren O'Donnell (1999-), Steve Pieper (2001-) Pis: Ron Kikinis, Ferenc Jolesz, Eric Grimson, William Wells III

6. Brigham and Women’s Hospital Image Guided Therapy Program Slicer 97

7. Brigham and Women’s Hospital Image Guided Therapy Program Multiple applications Software design to maximize function commonalities among applications –Brain (biopsy, craniotomy, NdYAG laser ablation) –Prostate (brachytherapy, biopsy) –Liver and kidney (Microwave, laser ablation) –Endoscopy (neuroendoscopy)

8. Brigham and Women’s Hospital Image Guided Therapy Program Neurosurgery DICOM image transfer Visualization Navigation Image registration

9. Brigham and Women’s Hospital Image Guided Therapy Program “Multi-modality” MRIg Surgery Registration is the key-enabling technology

10. Brigham and Women’s Hospital Image Guided Therapy Program ACADEMIC RADIOLOGY 10 (12): 1442-1449 DEC 2003 MR-guided Liver ablation Therapy

11. Brigham and Women’s Hospital Image Guided Therapy Program MRI-guided Thermal Therapy Comput Med Imaging Graph Image display DICOM transfer Thermal mapping (modifying fMRI module)

12. Brigham and Women’s Hospital Image Guided Therapy Program MRI-guided prostate therapy DICOM image transfer Rigid and non- rigid image registration Planning Scanner control Radiology 220(1), 263-268, 2001

13. Brigham and Women’s Hospital Image Guided Therapy Program Slicer with Hitachi scanner DICOM image transfer Patient-to-image registration Navigation Tumor segmentation for resection monitoring

14. Brigham and Women’s Hospital Image Guided Therapy Program Pituitary tumor in horizontal open-MRI 3D Slicer (Freeware) Navigation tool for image-guided therapy

15. Brigham and Women’s Hospital Image Guided Therapy Program Intraoperative Tumor Segmentation ITK-VTK-Slicer Fuzzy connectivity 30+ cases at 0.3T Hitachi Horizontal gap scanner Hata N, Muragaki Y, Inomata T, Maruyama T, Iseki H, Hori T, Dohi T. Intraoperative tumor segmentation and volume measurement in MRI-guided glioma surgery for tumor resection rate control. Acad Radiol. 2005;12(1):116-22.

16. Brigham and Women’s Hospital Image Guided Therapy Program Linking commercial navigation and research software 3D Slicer –Segmentation –Pre-Op to Intra-Op image registration –Navigation Toshiba navigation (pre- commercial) TCP/IP peer-to-peer connection –Patient-to-image registration result –Tracking data

17. Brigham and Women’s Hospital Image Guided Therapy Program Slicer for Surgical Robot Robot as tracking device

18. Brigham and Women’s Hospital Image Guided Therapy Program Slicer with Hitachi scanner

19. Brigham and Women’s Hospital Image Guided Therapy Program

20. System Integration to Signa/SP Off-the-shelf system + 3D Slicer TPS MRT Workstation BIT-3 10 Mbps Image Transfer 0.5fps Image Transfer 0.5fps Slicer

21. Brigham and Women’s Hospital Image Guided Therapy Program System Integration to Signa/SP (Pre-) MR Slicer TPS MRT Workstation BIT-3 100 Mbps Echo transfer 128fps Echo Transfer 128fps Slier Image Transfer 32fps Recon

22. Brigham and Women’s Hospital Image Guided Therapy Program GE Medical Systems Signa Horizon LX System –Host SGI Workstation / MIPS Based Processor IRIS Operating System (SGI) –Transceiver, Processing and Storage (TPS) VME / Motorola Based Processor VxWorks (Wind River) TPS Host Scanner

23. Brigham and Women’s Hospital Image Guided Therapy Program Reconstruction WS –CPU: Intel Pentium4 2.8 GHz (i850 Chipset) –Memory: 512MB (PC1066 RIMM) –Graphics: nVIDIA GeForce4 MX440 –OS: RedHat Linux 7.3, Kernel 2.4.18 with nVIDIA Graphics Driver Software –Real-time display of echo and k-space –Real-time image reconstruction –Navigator-echo based matching –Host control

24. Brigham and Women’s Hospital Image Guided Therapy Program MR Image reconstruction (+motion tracking)

25. Brigham and Women’s Hospital Image Guided Therapy Program Slicer as Interface

26. Brigham and Women’s Hospital Image Guided Therapy Program IGT software as an integration platform Robot Pre-operative Diagnostic Imaging ImageProcessing Intra-operative imaging ImageProcessing Registration Observation Action Tracking probe NavigationNavigation Physician Treatment Patient

27. Brigham and Women’s Hospital Image Guided Therapy Program Issues Basic functions for Image Guided Therapy (visualization, image I/O, patient-to-image registration) are relatively easy to implement (thanks to VTK and ITK) Challenge 1: Develop and apply medical image processing technology to enable new therapy options Challenge 2: Provide meeting point for robotics, medical image processing, and bio-physics –Do not think IGT software as free navigation system –Think IGT software as an integration platform TO ENABLE NEW THERAPY