Assessment of DICOM Viewers Capable of Loading Patient-specific 3D Models Obtained by Different Segmentation Platforms in the Operating Room

Abstract

Patient-specific 3D models obtained by the segmentation of volumetric diagnostic images play an increasingly important role in surgical planning. Surgeons use the virtual models reconstructed through segmentation to plan challenging surgeries. Many solutions exist for the different anatomical districts and surgical interventions. The possibility to bring the 3D virtual reconstructions with native radiological images in the operating room is essential for fostering the use of intraoperative planning. To the best of our knowledge, current DICOM viewers are not able to simultaneously connect to the picture archiving and communication system (PACS) and import 3D models generated by external platforms to allow a straight integration in the operating room. A total of 26 DICOM viewers were evaluated: 22 open source and four commercial. Two DICOM viewers can connect to PACS and import segmentations achieved by other applications: Synapse 3D® by Fujifilm and OsiriX by University of Geneva. We developed a software network that converts diffuse visual tool kit (VTK) format 3D model segmentations, obtained by any software platform, to a DICOM format that can be displayed using OsiriX or Synapse 3D. Both OsiriX and Synapse 3D were suitable for our purposes and had comparable performance. Although Synapse 3D loads native images and segmentations faster, the main benefits of OsiriX are its userfriendly loading of elaborated images and it being both free of charge and open source.

Automating Perforator Flap MRA and CTA Reporting

“…However, this new popularity of perforator CTA and MRA has created workflow issues due to the tedious task of reporting perforator details with precise coordinates. Several software techniques including the use of OsiriX for 3D mapping of the perforator arteries have been reported [8][9][10][11][12][13]. However, to our knowledge, this is the first report of an automated plugin developed exclusively for perforator mapping which created a complete report, thereby making the pre-operative imaging more accessible to radiologists and solving several workflow-related issues.…”

A Survey of DICOM Viewer Software to Integrate Clinical Research and Medical Imaging

“…Of course, there are other application scenarios other than the three we defined. Recently, Lo Presti et al analyzed 26 open source and commercial DICOM viewers with regard to their ability to read in 3D models from a PACS, which are generated from external segmentation systems, such as the visualization toolkit (VTK) [21]. For this special-use case, they identified Synapse 3D and OsiriX as optimal.…”

How Many Streamlines are Required for Reliable Probabilistic Tractography? Solutions for Microstructural Measurements and Neurosurgical Planning

“…Several arguments exist for the conversion of probabilistic tractography into this format. For example, overlaying images with raw streamline files or non-binary voxelwise representations thereof is not well supported by Picture Archiving and Communications System (PACS) oriented DICOM viewers that are central to clinical workflows (9,10). Clinicians are also generally more familiar with the more simplistic visualisations from deterministic diffusion tensor tractography that historically have dominated tractography research in surgical journals (for a review, see (11)).…”