Liver surgical resection is one of the most frequently used curative therapies. However,
resectability is problematic. There is a need for a computer-assisted surgical planning and
simulation system which can accurately and efficiently simulate the liver, vessels and
tumours in actual patients. The present project describes the development of these core
segmentation and deformable modelling techniques.
For precise detection of irregularly shaped areas with indistinct boundaries, the
segmentation incorporated active contours - gradient vector flow (GVF) snakes and level sets.
To improve efficiency, a chessboard distance transform was used to replace part of the GVF
effort. To automatically initialize the liver volume detection process, a rotating template was
introduced to locate the starting slice. For shape maintenance during the segmentation
process, a simplified object shape learning step was introduced to avoid occasional
significant errors. Skeletonization with fuzzy connectedness was used for vessel
segmentation.
To achieve real-time interactivity, the deformation regime of this system was based
on a single-organ mass-spring system (MSS), which introduced an on-the-fly local mesh
refinement to raise the deformation accuracy and the mesh control quality. This method was
now extended to a multiple soft-tissue constraint system, by supplementing it with an
adaptive constraint mesh generation. A mesh quality measure was tailored based on a wide
comparison of classic measures. Adjustable feature and parameter settings were thus
provided, to make tissues of interest distinct from adjacent structures, keeping the mesh
suitable for on-line topological transformation and deformation.
More than 20 actual patient CT and 2 magnetic resonance imaging (MRI) liver
datasets were tested to evaluate the performance of the segmentation method. Instrument
manipulations of probing, grasping, and simple cutting were successfully simulated on
deformable constraint liver tissue models. This project was implemented in conjunction with
the Division of Surgery, Hammersmith Hospital, London; the preliminary reality effect was
judged satisfactory by the consultant hepatic surgeon.