An Interactive, Patient-Specific Virtual Surgical Planning System for Upper Airway Obstruction Treatments

ABSTRACTUpper airway surgery encompasses a group of procedures commonly used to treat upper airway obstructionincluding maxillomandibular advancementsurgery of the soft palatenasal surgerytongue reduction surgeryand correction of tracheal stenosisCurrent diagnosis and the subsequent decision making of these pathologies primarily rely on the clinical examination and objective measures such as acoustic rhinometry and rhinomanometry that do not correlate well with patient symptomsThe lack of dependable objective measures has resulted in improper procedural prescriptions and less accurate surgical correctionsIn our Phase I projectwe developed a virtual surgical planning system that incorporates computational fluid dynamicsCFDsimulations to address the clinical need for objectivereproducible and personalized surgical proceduresThe Phase I project was executed with combined expertise in software developmentbiomechanical modeling of nasal airway passagesmathematical modeling of fluid flows and upper airway surgical treatment from the Medical College of WisconsinMCWUniversity of North CarolinaUNCand KitwareThe biophysical metrics computed from CFD models correlated well with subjective measures of symptoms before and after surgeryThe GPU based implementation of our Lattice Boltzmann flow simulation provided a continuous feedback and furnished rapid updates of the flow field and metrics engendered by each virtual surgeryThe Phase I proof of concept study has successfully achieved its aims and provided a solid understanding of the challenges and opportunities in clinical deployment of virtual surgical planningIn this Phase II projectwe willExtend and refine the virtual surgery and airflow simulation technology developed in Phase IBuild a web based application to deploy our patient specificgeometrical and simulation based surgical planning system in a cloud based infrastructureandConduct a validation study to evaluate the impact of virtual surgery modeling on surgeon decision making for upper airway surgical planningAt the successful completion of these aimswe will have completed the groundwork needed to launch the commercialization effortIn summarythe innovation in this proposal lies in the unique strategy to build a continuous feedbackpatient specificgeometrical and air flow simulation based surgical planning systemThe significance of this proposal lies in that the proposed surgical modeling system will be a powerful tool to provide surgeons with reliablepatient specific objective measures to improve patient outcomes Project NarrativeUpper airway surgery encompasses a group of procedures commonly used to treat upper airway obstructionincluding maxillomandibular advancementsurgery of the soft palatenasal surgerytongue reduction surgeryand correction of tracheal stenosisCurrent surgical procedures lack dependable objective measures resulting in improper procedural prescriptions and surgical corrections with low long term success rateIn this projectwe aim to maximize the surgical success rate through informed decision making achieved using an interactive patient specificsurgical planning system that can provide quantitative physical metrics based on accurate airflow simulations