Image Fusion for Computer-assisted Bone Tumor Surgery

Abstract

The fusion of computed tomography and magnetic resonance images is a software-dependent processing technique that enables one to integrate and analyze preoperative images for planning complex musculoskeletal tumor resections. By integrating various imaging modalities into one imaging data set we may facilitate preoperative image analysis and planning of navigation computer-assisted bone tumor resection and reconstruction. We performed image fusion for computer-assisted tumor surgery in 13 consecutive patients, seven males and six females, with a mean age of 35.8 years (range, 6-80 years). Visual verification of fused images was accurate in all patients. The mean time for image fusion was 30.6 minutes (range, 8-80 minutes). After intraoperative registration, all tumor resections were performed as planned preoperatively under navigation image guidance. Resections achieved after navigation resection planning were validated by postoperative CT or resected specimens in seven patients. Histologic examination of all resected specimens showed tumor-free margins in patients with bone sarcoma. The fusion of computed tomography and magnetic resonance imaging has the potential to enhance computer-assisted bone tumor surgery. The fusion image, when combined with surgical navigation, helps surgeons reproduce a preoperative plan reliably and may offer substantial clinical benefits.

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

“…This navigation system was used for the first three patients while another navigation system (iNtellect Cranial, Version 1.1; Stryker Navigation) was used for the rest. The process of fusing multimodal image data sets has been described [16]. We used the cranial navigation software for image fusion in the latter part of the study as it allowed automatic fusion of various image data sets regardless of imaging modalities and scan orientation.…”

“…5). Intraoperative navigation has been described [16][17][18]. After appropriate surgical exposure, a dynamic reference patient tracker was attached to the bone in which the tumor was located.…”

“…However, it is difficult to relate the tumor margins on preoperative CT and/or MR images to the actual extent of the tumor in the bone and to precisely carry out the resection in the operating room without the use of an image guidance or surgical navigation system. Computer-assisted tumor surgery may facilitate the precise resection of the bone tumor and may enable an accurate reconstruction to be performed [14,[16][17][18]. Joint-preserving resections require a high level of precision and may be facilitated with the use of a surgical navigation system [4,17].…”

“…Joint-preserving resections require a high level of precision and may be facilitated with the use of a surgical navigation system [4,17]. Short-and intermediate-term studies show no increase in local recurrence rates when compared to conventional jointsacrificing surgery [4,16].…”

Transfer accuracy and precision scoring in planar bone cutting validated with ex vivo data

“…Its use has been reported in knee osteotomy, 1 mandibular reconstruction, 2 spine surgery, 3 foot and ankle surgery, 4 and tumor resection. 5 The existence of virtual osteotomy planning opens the possibility of measuring the discrepancies that occur in the transfer from the target to the executed osteotomies. These discrepancies are very common since many factors add random variations and biases to the surgical process: CT/MR imaging errors, three-dimensional modeling and segmentation omissions and the inherent inaccuracies of surgical tools and actions.…”