Virtual 3D tumor marking-exact intraoperative coordinate mapping improve post-operative radiotherapy

Abstract

The quality of the interdisciplinary interface in oncological treatment between surgery, pathology and radiotherapy is mainly dependent on reliable anatomical three-dimensional (3D) allocation of specimen and their context sensitive interpretation which defines further treatment protocols. Computer-assisted preoperative planning (CAPP) allows for outlining macroscopical tumor size and margins. A new technique facilitates the 3D virtual marking and mapping of frozen sections and resection margins or important surgical intraoperative information. These data could be stored in DICOM format (Digital Imaging and Communication in Medicine) in terms of augmented reality and transferred to communicate patient's specific tumor information (invasion to vessels and nerves, non-resectable tumor) to oncologists, radiotherapists and pathologists.

Marking of tumor resection borders for improved radiation planning facilitates reduction of radiation dose to free flap reconstruction in head and neck cancer surgery

“…Surgical navigation has become an established technique in the field of head and neck surgery (Schramm et al, 2008). 3D virtual marking and mapping of resection margins enables precise delineation of skull base and midface tumor margins (Essig et al, 2011;Bittermann et al, 2013;GuijarroMartinez et al, 2014). This was confirmed in this investigation, although the patient collective was very small.…”

“…Delineation of reconstructed tissue from resection margins on postoperative CT scans is often difficult (Coles et al, 2009;Yang et al, 2013). Various refinements in the field of computer-aided surgery (CAS) have been implemented in order to improve marking of resection margins but CAS alone is insufficient in delineating tumor margins apart from hard tissue in soft tissue due to the effects of gravity and swelling on the tissue whether native or reconstructed (Essig et al, 2011;Bittermann et al, 2013). In this situation marking of margins by titanium ligature clips could be useful (Bittermann et al, 2013).…”

Clipping of tumour resection margins allows accurate target volume delineation in head and neck cancer adjuvant radiation therapy

“…The localisation of the malignancy within the excised specimen and consequently a possible close margin resection would remain disregarded. Integrating of histological information in a navigation assisted multidisciplinary network can overcome these difficulties [8,19].…”

Development and first clinical application of automated virtual reconstruction of unilateral midface defects

“…The main clinical applications of CAS in craniomaxillofacial surgery are trauma Mustafa et al, 2011), reconstruction of malformations and post-tumor ablation defects (Westendorff et al, 2007;Essig et al, 2011a), secondary reconstruction (Watzinger et al, 1997;Gellrich et al, 2002), and orthognathic surgery (Zizelmann et al, 2012;Gander et al, 2015a) Segmentation of pathologic soft tissue structures has gained more popularity over the last few years (Schramm et al, 2008). Such segmentation can be used not only for tumor resection but also for postoperative radiotherapy (Essig et al, 2011b). In addition, CAS can be used to compensate for missing landmarks in discrete defects (Hammer and Prein, 1995).…”