Real-Time Ultrasound Guided Abdominal Interventions Without a Tracking Device

This project aims to improve the ability of clinicians to diagnose and treat cancer, focussing on two specific procedures: laparoscopic liver resection and needle biopsy of the pancreas. Currently, both procedures require a high level of skill, resulting in a shortage of trained personnel, longer waiting lists and consequently delayed diagnosis or treatment, which is critical for the patient. Ultrasound imaging is commonly used to guide a variety of procedures. In laparoscopic liver resection for example, the surgeon will use ultrasound imaging to locate major blood vessels, and plan ahead. In endoscopic biopsy, the endoscopist will use ultrasound to navigate towards the pancreas and locate a specific tumour. However, both of these procedures are difficult, and carry the risk of mistakes. The ultrasound images are 2-dimensional (2D), and it is difficult to understand the location and orientation of the ultrasound image, with respect to the patient's anatomy. In addition, current research methods use expensive tracking devices and the software is difficult to use, so such methods cannot be commercialised or widely adopted, as they simply aren't user friendly.

We will develop new technology that will align 2D ultrasound images with 3-dimensional (3D) pre-operative scan data such as Magnetic Resonance (MR), or Computed Tomography (CT). This will give the clinician a much wider context, improve their understanding of the location and orientation of the ultrasound probe, and enable quicker procedures. In the longer term, this will make the procedure easier and quicker to perform, allowing more patients to be examined quicker. The increase awareness and 3D context may potentially lead to fewer mistakes, and lower risk, although this is harder to demonstrate.

To achieve this goal, we will exploit recent advances in machine learning to produce an algorithm that is reliable, robust and fast. New software will display the 2D ultrasound image, alongside the 3D scan and show the location of the ultrasound probe. We will deliver a method that does not require any extra equipment, does not hinder the clinical workflow, and does not require the clinician to interact with the software as it will be automatic and hands-free.

In the longer term, these methods will be applicable to other ultrasound-based procedures in laparoscopy, endoscopy, fetal surgery, robotic surgery and beyond. The benefit to the general public will be faster and safer procedures, and the technology will enable more clinicians to perform these procedures, resulting in shorter waiting lists, and earlier treatment for the patient.

In the UK there are approximately 10,000 new cases per year of pancreatic cancer and 5,000 for liver cancer. Management and treatment of cancer is one of the biggest challenges in medicine worldwide, and costs the UK economy over £15bn per year over all cancers. The predicted rise in the cost of cancer care requires new technology for earlier diagnosis and more effective treatment.

In this project, we will develop image-guidance systems that will make ultrasound biopsy of the pancreas, and ultrasound guidance during liver surgery, quicker, safer and easier to perform. Currently, 2-dimensional (2D) ultrasound is difficult to use, requiring very highly trained staff, which consequently results in a skills shortage in the NHS, and longer waiting lists for the patient. Patients often have a 3-dimensional Magnetic Resonance (MR) or Computed Tomography (CT) scan, which are used for diagnosis and treatment planning. Our aim is to produce software that can align ultrasound with MR/CT images, and thereby provide complementary information to the clinician which will make treatment or diagnostic procedures quicker, safer and easier to perform. The proposed technology could be applied in a wide variety of clinical procedures.

Early diagnosis can help reduce treatment costs and minimise the impact on the active workforce, resulting in earlier return to a normal life, and return to work. Early diagnosis is associated with increased survival. In this grant proposal, we have a focus on biopsy of pancreatic cancer. There is a current problem in the NHS in that many pancreatic cysts are found by incidental, non cancer-related imaging. However, only 20% of detected cysts will become cancerous. But there are not enough endoscopists to perform enough biopsies, resulting in lack of treatment, or over treatment. The proposed technology will make pancreatic biopsy easier to perform, for lesser trained staff, helping reduce the burden on the NHS and providing earlier diagnosis for patients.

Ultrasound imaging is also used to administer treatment. However, high-risk procedures carry the risk of major injury or death. In laparoscopic (keyhole) liver surgery, ultrasound is used to detect major blood vessels. However, some cancers are not visible in ultrasound imaging, but are visible on MR/CT scans. By providing both types of images in a navigation system, the surgeon can make better, more informed decisions. Laparoscopic surgery has been shown to reduce complications and enable faster recovery for the patient. But currently only 10% of liver surgery patients can be offered it, due to the complexity of the surgery. The technology we propose in this grant will enable more surgeons to attempt more liver surgery laparoscopically, resulting in better quality of life for patients.

In summary, the overall impact is:

1. For the patient, earlier diagnosis, or safer treatment, improved survival rate or quality of life.
2. For the NHS, reduce costs, reduced complications, reduce skills shortage, enable lesser trained staff to adopt new techniques, and increased workload.
3. For society, earlier return to work.