scholarly journals Virtual hepatic surgery scenarios using manipulated real liver models

2015 ◽  
Author(s):  
Apollon Zygomalas ◽  
Vasileios Megalooikonomou ◽  
Dimitrios Koutsouris ◽  
Dimitrios Karavias ◽  
Ioannis Karagiannidis ◽  
...  
Keyword(s):  
Preoperative Planning ◽  
Clinical Information ◽  
Patient Specific ◽  
Image Editing ◽  
Liver Imaging ◽  
Liver Segmentation ◽  
Hepatic Surgery ◽  
Liver Injuries ◽  
Segmentation Algorithms ◽  
Four Levels

Background. High quality patient specific 3D liver models can be nowadays exported using computer liver segmentation algorithms. Specific 3D image editing tools can be used to manipulate the liver models and create virtual surgical cases. Objective. The aim of our study was to create virtual hepatic surgery scenarios using a novel liver segmentation and preoperative planning application and evaluating it as an educational tool. Method. A liver segmentation and preoperative planning application was developed on MATLAB® 2013a. Special image editing tools were designed to allow manipulation of the exported 3D liver models. Three pathological and two liver imaging datasets from healthy patients were used for the validation. The 3D liver models which have been created after liver segmentation were then manipulated by; 1) changing tumors’ volumes, 2) adding tumors and 3) designing liver injuries. Addition fictitious clinical information were implemented. Residents were asked to study the virtual cases and propose resection plans. Their scenarios were evaluated and discussed with specialized liver surgeons. The Kirkpatrick’s four levels model of learning evaluation was used. Results. Up to 30 different virtual liver surgical cases were created. The number of virtual scenarios that could be designed is theoretically unlimited. The residents quickly and effectively learned to evaluate critical anatomical and pathological structures and propose liver resection plans considering liver surgery principles. Conclusions. Virtual hepatic surgery scenarios allowed for a rapid education without the need to wait for similar real cases. The proposed liver segmentation and hepatectomy simulation application can be used for educational purposes.

scholarly journals Virtual hepatic surgery scenarios using manipulated real liver models

2015 ◽  
Author(s):  
Apollon Zygomalas ◽  
Vasileios Megalooikonomou ◽  
Dimitrios Koutsouris ◽  
Dimitrios Karavias ◽  
Ioannis Karagiannidis ◽  
...  
Keyword(s):  
Preoperative Planning ◽  
Clinical Information ◽  
Patient Specific ◽  
Image Editing ◽  
Liver Imaging ◽  
Liver Segmentation ◽  
Hepatic Surgery ◽  
Liver Injuries ◽  
Segmentation Algorithms ◽  
Four Levels

Background. High quality patient specific 3D liver models can be nowadays exported using computer liver segmentation algorithms. Specific 3D image editing tools can be used to manipulate the liver models and create virtual surgical cases. Objective. The aim of our study was to create virtual hepatic surgery scenarios using a novel liver segmentation and preoperative planning application and evaluating it as an educational tool. Method. A liver segmentation and preoperative planning application was developed on MATLAB® 2013a. Special image editing tools were designed to allow manipulation of the exported 3D liver models. Three pathological and two liver imaging datasets from healthy patients were used for the validation. The 3D liver models which have been created after liver segmentation were then manipulated by; 1) changing tumors’ volumes, 2) adding tumors and 3) designing liver injuries. Addition fictitious clinical information were implemented. Residents were asked to study the virtual cases and propose resection plans. Their scenarios were evaluated and discussed with specialized liver surgeons. The Kirkpatrick’s four levels model of learning evaluation was used. Results. Up to 30 different virtual liver surgical cases were created. The number of virtual scenarios that could be designed is theoretically unlimited. The residents quickly and effectively learned to evaluate critical anatomical and pathological structures and propose liver resection plans considering liver surgery principles. Conclusions. Virtual hepatic surgery scenarios allowed for a rapid education without the need to wait for similar real cases. The proposed liver segmentation and hepatectomy simulation application can be used for educational purposes.

scholarly journals Liver 3D modeling and hepatectomy simulation for the residents’ preoperative education

2015 ◽  
Author(s):  
Apollon Zygomalas ◽  
Vasileios Megalooikonomou ◽  
Dimitrios Koutsouris ◽  
Dimitrios Karavias ◽  
Ioannis Karagiannidis ◽  
...  
Keyword(s):  
Liver Resection ◽  
3D Modeling ◽  
Preoperative Planning ◽  
Medical Images ◽  
Patient Specific ◽  
Computer Assisted ◽  
Liver Imaging ◽  
Liver Segmentation ◽  
Preoperative Education ◽  
Liver Remnant

Background. Liver segmentation from medical images produces high quality patient specific 3D liver models which are used for preoperative planning and intraoperative guidance. These 3D models can be manipulated and visualized in various ways and can be useful for residents’ education. Objective. The aim of this study was to evaluate the implementation of a novel liver segmentation and hepatectomy simulation application as a tool for the residents’ preoperative education. Method. We developed in MATLAB® 2013a a liver segmentation and preoperative planning application. Ten liver imaging datasets of a prospectively selected random sample of patients undergoing elective hepatectomies at our institution were used for liver segmentation and 3D modeling. Residents were asked to identify anatomical and pathological structures and propose liver resection plans. Intraoperatively, they could consult the computer models in real time. Their surgical scenarios were evaluated and discussed with specialized liver surgeons. Learning objectives were defined and their accomplishment was evaluated using the Kirkpatrick’s four levels model. Results. The residents learned to 1) identify anatomical and pathological structures 2) calculate future liver remnant volume (FLR) from segmented liver images 3) propose liver resection plans based on FLR and liver vascular tree and tumor relations 4) consult liver medical images (CT and MRI) 5) understand the role of computer assisted surgery. They evaluated in-vivo their preoperative planning decisions and understood better the surgical operations. Conclusions. Our proposed liver segmentation and hepatectomy simulation application appears to be appropriate for the preoperative education of resident surgeons.

scholarly journals Liver 3D modeling and hepatectomy simulation for the residents’ preoperative education

2015 ◽  
Author(s):  
Apollon Zygomalas ◽  
Vasileios Megalooikonomou ◽  
Dimitrios Koutsouris ◽  
Dimitrios Karavias ◽  
Ioannis Karagiannidis ◽  
...  
Keyword(s):  
Liver Resection ◽  
3D Modeling ◽  
Preoperative Planning ◽  
Medical Images ◽  
Patient Specific ◽  
Computer Assisted ◽  
Liver Imaging ◽  
Liver Segmentation ◽  
Preoperative Education ◽  
Liver Remnant

Background. Liver segmentation from medical images produces high quality patient specific 3D liver models which are used for preoperative planning and intraoperative guidance. These 3D models can be manipulated and visualized in various ways and can be useful for residents’ education. Objective. The aim of this study was to evaluate the implementation of a novel liver segmentation and hepatectomy simulation application as a tool for the residents’ preoperative education. Method. We developed in MATLAB® 2013a a liver segmentation and preoperative planning application. Ten liver imaging datasets of a prospectively selected random sample of patients undergoing elective hepatectomies at our institution were used for liver segmentation and 3D modeling. Residents were asked to identify anatomical and pathological structures and propose liver resection plans. Intraoperatively, they could consult the computer models in real time. Their surgical scenarios were evaluated and discussed with specialized liver surgeons. Learning objectives were defined and their accomplishment was evaluated using the Kirkpatrick’s four levels model. Results. The residents learned to 1) identify anatomical and pathological structures 2) calculate future liver remnant volume (FLR) from segmented liver images 3) propose liver resection plans based on FLR and liver vascular tree and tumor relations 4) consult liver medical images (CT and MRI) 5) understand the role of computer assisted surgery. They evaluated in-vivo their preoperative planning decisions and understood better the surgical operations. Conclusions. Our proposed liver segmentation and hepatectomy simulation application appears to be appropriate for the preoperative education of resident surgeons.

Full tractography for detecting the position of cranial nerves in preoperative planning for skull base surgery: technical note

2020 ◽  
Vol 132 (5) ◽  
pp. 1642-1652 ◽  
Author(s):  
Timothee Jacquesson ◽  
Fang-Chang Yeh ◽  
Sandip Panesar ◽  
Jessica Barrios ◽  
Arnaud Attyé ◽  
...  
Keyword(s):  
Skull Base ◽  
Preoperative Planning ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Patient Specific ◽  
Small Scale ◽  
Skull Base Tumor ◽  
Skull Base Tumors ◽  
Brain White Matter ◽  
Human Connectome Project

OBJECTIVEDiffusion imaging tractography has allowed the in vivo description of brain white matter. One of its applications is preoperative planning for brain tumor resection. Due to a limited spatial and angular resolution, it is difficult for fiber tracking to delineate fiber crossing areas and small-scale structures, in particular brainstem tracts and cranial nerves. New methods are being developed but these involve extensive multistep tractography pipelines including the patient-specific design of multiple regions of interest (ROIs). The authors propose a new practical full tractography method that could be implemented in routine presurgical planning for skull base surgery.METHODSA Philips MRI machine provided diffusion-weighted and anatomical sequences for 2 healthy volunteers and 2 skull base tumor patients. Tractography of the full brainstem, the cerebellum, and cranial nerves was performed using the software DSI Studio, generalized-q-sampling reconstruction, orientation distribution function (ODF) of fibers, and a quantitative anisotropy–based generalized deterministic algorithm. No ROI or extensive manual filtering of spurious fibers was used. Tractography rendering was displayed in a tridimensional space with directional color code. This approach was also tested on diffusion data from the Human Connectome Project (HCP) database.RESULTSThe brainstem, the cerebellum, and the cisternal segments of most cranial nerves were depicted in all participants. In cases of skull base tumors, the tridimensional rendering permitted the visualization of the whole anatomical environment and cranial nerve displacement, thus helping the surgical strategy.CONCLUSIONSAs opposed to classical ROI-based methods, this novel full tractography approach could enable routine enhanced surgical planning or brain imaging for skull base tumors.

scholarly journals Current Practice in Preoperative Virtual and Physical Simulation in Neurosurgery

2020 ◽  
Vol 7 (1) ◽  
pp. 7 ◽  
Author(s):  
Elisa Mussi ◽  
Federico Mussa ◽  
Chiara Santarelli ◽  
Mirko Scagnet ◽  
Francesca Uccheddu ◽  
...  
Keyword(s):  
Clinical Practice ◽  
3D Printing ◽  
Surgical Planning ◽  
Physical Simulation ◽  
Planning Process ◽  
Preoperative Planning ◽  
Cost Effective ◽  
Patient Specific ◽  
Anatomical Models ◽  
Standard Clinical Practice

In brain tumor surgery, an appropriate and careful surgical planning process is crucial for surgeons and can determine the success or failure of the surgery. A deep comprehension of spatial relationships between tumor borders and surrounding healthy tissues enables accurate surgical planning that leads to the identification of the optimal and patient-specific surgical strategy. A physical replica of the region of interest is a valuable aid for preoperative planning and simulation, allowing the physician to directly handle the patient’s anatomy and easily study the volumes involved in the surgery. In the literature, different anatomical models, produced with 3D technologies, are reported and several methodologies were proposed. Many of them share the idea that the employment of 3D printing technologies to produce anatomical models can be introduced into standard clinical practice since 3D printing is now considered to be a mature technology. Therefore, the main aim of the paper is to take into account the literature best practices and to describe the current workflow and methodology used to standardize the pre-operative virtual and physical simulation in neurosurgery. The main aim is also to introduce these practices and standards to neurosurgeons and clinical engineers interested in learning and implementing cost-effective in-house preoperative surgical planning processes. To assess the validity of the proposed scheme, four clinical cases of preoperative planning of brain cancer surgery are reported and discussed. Our preliminary results showed that the proposed methodology can be applied effectively in the neurosurgical clinical practice both in terms of affordability and in terms of simulation realism and efficacy.

scholarly journals Computer-Assisted Planning and Three-Dimensional-Printed Patient-Specific Instrumental Guide for Corrective Osteotomy in Post-Traumatic Femur Deformity: A Case Report and Literature Review

2018 ◽  
Vol 24 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Lau Chi-Kay ◽  
Chui King-him ◽  
Lee Kin-bong ◽  
Li Wilson
Keyword(s):  
Lower Limb ◽  
New Technologies ◽  
Preoperative Planning ◽  
Corrective Osteotomy ◽  
Three Dimensional ◽  
Patient Specific ◽  
Computer Assisted ◽  
Limb Deformity ◽  
Satisfactory Outcome ◽  
Post Traumatic

Post-traumatic limb deformity is often multiplanar and thus is a difficult pathology to deal with surgically. Precise preoperative planning and accurate intraoperative execution are two main important steps that lead to satisfactory outcome. Computer-assisted planning and three-dimensional-printed patient-specific instrumental guides provide excellent aid to the two steps, respectively. We report a case of posttraumatic lower limb deformity in a patient who underwent closing wedge corrective osteotomy with the aid of the aforementioned new technologies.

Decision Support at the Point of Care: Challenges in Knowledge Representation, Management, and Patient-specific Access

2003 ◽  
Vol 17 (1) ◽  
pp. 69-73 ◽  
Author(s):  
R.A. Greenes
Keyword(s):  
Decision Support ◽  
Clinical Information System ◽  
Point Of Care ◽  
Medical Knowledge ◽  
User Interaction ◽  
Clinical Information ◽  
Patient Specific ◽  
Local Environments ◽  
Computer Based ◽  
Application Specific

Many applications in a clinical information system can benefit from the incorporation of medical knowledge to provide patient-specific, point-of-care decision support. These include computer-based provider order entry, referral, clinical result interpretation, consultation, adverse event monitoring, scheduling, shared patient-doctor decision-making, and generation of alerts and reminders, among others. To be executable, knowledge must be represented in the form of rules, constraints, calculations, guidelines, and other logical/algorithmic formats. The main difficulty is that the integration of such knowledge into clinical applications, when it occurs, tends to be very system- and application-specific, often encoded in a programming language, or even in the formating specifications of a user interaction display. Also, the data references and services invoked are highly dependent on the system/platform and electronic medical record implementation. This makes it difficult and time-consuming to encode authoritative evidence-based knowledge, severely limits the ability to disseminate and share successes, and hampers efforts to review and update the logic as medical knowledge changes. Solutions to this problem involve the development of standards-based representations for medical knowledge, and tools for authoring/editing, dissemination, adaptation to local environments, and execution. Numerous approaches are being pursued, all of which will be described in this presentation.

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