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High Confidence Software for Image- Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of Surgery Director, Center for Technology- Guided Therapy Vanderbilt University, Nashville TN

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Page 1: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

High Confidence Software for Image-Guided Therapy

Robert L. Galloway, PhDProfessor of Biomedical Engineering,

Professor of Neurosurgery, Professor of SurgeryDirector, Center for Technology-Guided Therapy

Vanderbilt University, Nashville TN

Page 2: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Disclosure

Robert L, Galloway PhD is a Founder, President and Chief Technical Officer of Pathfinder Therapeutics Inc

Nashville TN

Page 3: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

TGT

Page 4: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Technology-Guided Therapy

The central principle behind TGT is that therapy delivery is as important as the therapeutic

process.

Page 5: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Technology-Guided Therapy

The use of images, not as pictures but as maps.

Page 6: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Technology-Guided Therapy• Need images and knowledge of the

information images convey and their spatial characteristics.

• Need a three (or six) dimensional tracking system.

• Need a methodology for the visualization of path, structures and target.

• Need a method of registration from physical space to image spaces (s)

Page 7: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

TGT

Page 8: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Image-Guided Liver Surgery

Page 9: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Cortical Surface Mapping

Page 10: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Patient #1

Page 11: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Comparison between digital and physical labels:

Page 12: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

New Surgical Applications

• One of the most prevalent cancers in the US

• Visualization of the layered structure of the rectum is important for staging and therapy

• Macular degeneration leading cause of adult blindness.

• Responds to drug treatment of the back of the eye and optic nerves.

OphthalmologyColorectal Cancers

Page 13: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

New Therapeutic Applications

• Creation of Dose distribution

• Guidance of the placement of sources

• Only available therapy for the profoundly deaf

• Outcome tends to be binary

• 1% morbidity (Facial nerve)

Cochlear ImplantationGene Therapy

Page 14: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Software Design

Page 15: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

ORION Software Design

Video

Tomogram

Rotational

2-D Images

DisplayOptotrak

Polaris

Shape Tape

Magnetic

Localizer

Render

Biopsy

Preop Plan

Transparency

GraphicA-Mode US

Electrophys.

Biomechanical

Optical Biopsy

IO

Quaternion

SVD

HTM

ICP

Registration

Deformation

Functional

Correction

ORION

TGT

Page 16: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

ORION

• Based on Dynamic Link Libraries so only functionality needed at runtime is loaded.

• Allows inclusion of new functionality without changing underlying code.

• Written in Visual C, Windows API and runs under Windows 98/Me/NT/2000/XP.

TGT

Page 17: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

New Software Design Functional Classes, Present

State• Display

– Tomograms, rotational sets and video

• Localizer – Optotrak– Polaris/Aurora– Polhemus– Other

• Registration – Point-based quaternion

and SVD– point based HTM– ICP surface

• Graphics – two types of overlay

supported– on the fly rendering

(Open GL)– Preoperative plan

• IO– Neurostimulator

• Corrections– Model Updated

TGT

Page 18: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Provocation #1

HIPAA is dangerous to patients.

Constraint of information and patient identification will lead to patient-information mismatches.

Page 19: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Provocation #2

Hippocrates was wrong.

In analyzing software’s potential dangerto one subject is to deny other potential patients timely access to the technology. Such an approach also serves as a barrier to revision.

Page 20: High Confidence Software for Image-Guided Therapy Robert L. Galloway, PhD Professor of Biomedical Engineering, Professor of Neurosurgery, Professor of

Bio

Robert L. Galloway, Jr. is a Professor of Biomedical Engineering, Neurological Surgery, and Surgery at Vanderbilt University. He teaches courses in Medical Instrumentation, Medical Imaging and Therapeutic Bioengineering. He has won half a dozen Excellences in Teaching and Professor of the Year awards. Galloway's research entails the design of systems for Interactive, Image-Guided Surgery, and holds 9 U.S. and international patents on devices arising from his research. He has published 75 manuscripts in refereed journals, edited books, and presented results of his work at over 90 scientific meetings. Galloway is a co-founder of Pathfinder Therapeutics Inc. and serves as President and CTO. He received a B.S. degree in Engineering. and Ph.D. from Duke, and a Masters in Engineering from UVA, all in Biomedical Engineering.


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