3-D影像，外科机器人进入介入领域

3-D Imaging, Robotic Surgeons Entering the Interventional Arena   

      Robert S. Schwartz医生预言真正的3-D影像系统以及外科机器人将在不远的将来“入侵”导管室，而且非常具有前景。

 
     Schwartz 医生是Minneapolis心脏学院的介入心脏病学医师。在本周（2008年10月13日至19日）的TCT电视转播上，对于目前最新的技术，他先睹为快。

      " Schwartz说：“我们（人类）在进化的过程当中学会了处理3-D信息，而当今的（影像）系统不具备这样的能力，不能够在平面的屏幕上显示出冠状动脉的（立体）迂回曲折。”

      阴影恢复算法可以显示深度，但是平面图形给导航带来困难。“通过平面显示器的观察并不是真正的3-D影像，”他说道。

新的3-D技术
      这正是为什么Schwartz医生对新的3-D技术感到非常兴奋的原因。有两种系统现在正在开发中。第一种需要玻璃镜片将分裂的图形整合成三维图形，很像上世纪50年代电影院里常见的笨重眼镜的现代版本。但是第二种技术展示的才是真正的3-D全息图，Schwartz医生认为这一进步将改变对疾病的诊断和治疗。

      这些系统将通过显示慢性完全闭塞的位置、构成以及迂回曲折的位置和如何最好地移动导丝来来帮助我们穿过（狭窄部位）。但这还是介入心脏病学的前沿，Shwartz说。

      好莱坞队这些技术表示了兴趣，而且这些新开发的技术最终将变成主流。影像技术的进展比较特别，是由视频游戏产业推动的。我们（影像学的进步）应该感谢这个产业。Schwartz说。

导管实验室里的机器人
      他预言，机器人将很快“入侵”导管室。DaVinci机器人现在可以处理一些前列腺和脑外科手术。下一代类DaVinci机器人正在为应用到介入心脏病学领域而在开发过程当中。

      如Swhwartz所说，这些系统将使得操作者能够“坐在射线屏后面进行导管室里的复杂微创外科手术。而因此我们也将可以脱掉铅衣坐下来（做手术了）。”

      这些机器人还将感觉传递给医生带着的手套，比如闭塞的质地。机器人将从…导丝的端头收集信号并转化成我们的手部可以感知的信号并且还能增强这些信号。

       “如果你试图穿过一处CTO，你将能够感觉到钙化的位置。这里是不是柔软的组织？这里是不是硬的组织？ 我是不是碰壁了？我认为（手术的）安全性将会被显著地提升。”他说到。

      Schwartz还对CT与MR影像技术的同时应用进行了评论。CT提供高的空间分辨率，MRI提供功能性组织的影像。大多数人认为这两种技术是竞争的，然而他们并不是（竞争的）。

      相反，他相信二者彼此互补并且将最终被整合入介入手术装置，成为一个很小的系统。

（《医心评论》：孟祥飞 译  马秀芹 校)

3-D Imaging, Robotic Surgeons Entering the Interventional Arena    
 
Key Points:

3-D holograms could transform diagnosis and therapy.

By TCT Daily Staff

Robert S. Schwartz, MD, has seen the future and it looks, well, futuristic. He sees true 3-D imaging systems and robotic surgeons invading cath labs in the
near future.

As an interventional cardiologist at the Minneapolis Heart Institute, Schwartz keeps up with the latest technologies, which he previewed for TCT TV this week.

"We evolved as creatures that can process 3-D information," Schwartz said. Current systems fail to take advantage of these abilities by representing the 3-D twists and turns of the coronary artery landscape on a flat screen.

Shading algorithms represent depth, but flat images make navigation difficult. "Looking at a flat screen is not true 3-D" imaging, he said.

New 3-D technologies

That’s why Schwartz is so excited about new 3-D technologies. Two types of systems are in development. The first requires glasses that help integrate split images into three dimensions, much like a sophisticated version of the clunky glasses found in movie theaters in the 1950s. But the second technology displays true 3-D holograms, an advancement that Schwartz thinks will transform diagnosis and therapy.

These systems "will help us get through chronic total occlusions by showing us where they are, what they are made of, where the twists and turns are, and how best to move the guidewire through the lesion. That’s the remaining frontier of interventional cardiology," Schwartz said.

Hollywood has shown interest in these technologies, and these new developments will eventually become mainstream. Advances in imaging technology, in particular, are being driven by the video game industry. "We owe [imaging advances] to that industry," Schwartz said.

Robots in the cath lab

Robots will soon invade cath labs, Schwartz predicted. The DaVinci robot currently handles some prostate and brain surgeries. The next generation of DaVinci-like robots is being developed for interventional cardiology.

These systems will allow practitioners "to perform multiple invasive procedures in the cath lab while sitting behind radiation screens," Schwartz said. "So we will be able to take the lead off and sit down."

The robots will transmit sensations, such as the texture of an occlusion, to gloves worn by the physician. "The robot will take signals coming from … the tip of the guidewire and translate those so that you can feel it with your hands and amplify the signal," he said.

"If you’re trying to get through a chronic total occlusion, you will feel where the calcium is," he said. "Is there soft tissue here, is there hard tissue here? Am I up against the wall? I think safety will be markedly improved."

Schwartz also sees CT and MR imaging technologies working together. CT offers higher spatial resolution, while MRI provides functional tissue imaging. "Most people think the two technologies are competitive but they really aren’t," he said.

Instead, he believes they complement each other and will eventually be integrated in small systems that fit into the interventional suite.

Disclosures:

Dr. Schwartz reports no relevant conflicts of interest.

（source：www.tctmd.com）