Nova era do planejamento cirúrgico endovascular

Abstract

In vascular surgery, we have definitively entered the digital age, leaving the age of calipers behind. Disruptive technology is a new term that describes the technological innovation, a product or service that displaces current technology, unlike the revolutionary innovations that introduce a technology for higher performance in the market 1 . We should learn how to use new tools properly and gradually identify their new benefits.Today, we have several diagnostic methods available that generate huge amounts of information; this way, the old medical analysis of negatoscope images is becoming obsolete. X-ray imaging visualization was properly provided by the negatoscope, but, with the advent of tomography and magnetic resonance, the images started to be precise in axial (coronal or sagittal) cross-sections, requiring more and more printed sheets. It makes it difficult to analyze the exam, increases the exam cost and pollutes the environment.Computed tomography (CT) and magnetic resonance (MR) continue to evolve, generating more information, with thinner and more cross-sections. What could be presented before in tens of axial cross-sections, now employs thousands of cross-sections. In addition, the almost infinite possibilities of multiplanar reconstructions that allow oblique cross-sections have made it obsolete the analysis of printed images only.3D volume reconstruction, already in use, is an analysis technique that add up data from all axial cross-sections and summarizes them in few images. The relevant information can be quickly printed in a few pages, but it is not reliable for more accurate analysis, such as diameter and distance measurements, which are very important in endovascular surgery planning. Other reconstructions, such as orthogonal, multiplanar and curved planes, were developed to fulfill such demand, allowing very precise measurements at angles never imagined before.In the past, 3D reconstruction was restricted to dedicated computers called workstations, very expensive and limited to radiology use. However, with the evolution of personal computers, it is possible to have, at home, in the emergency room, in the outpatient care unit, or even in a mobile, a computer almost as powerful as a workstation dedicated to medical images and capable to create images of amazing quality and speed.The big question, a while ago, was the almost nonexistence of a software program suitable to DICOM image analysis for personal computers; the few available were very expensive and not accessible to the common user. Most physicians have already tried the limited software programs supplied in the exam CD and were surely frustrated with the experience. The website I Do Imaging (http://www.idoimaging.com/) offers many free programs for download that can run under any operating system; among these, OsiriX is our recommendation.The evolution of hardware and software has also allowed higher portability, with the use of tablets or smartphones (iPhone), which have a hand-held version of OsiriX, providing one more option of ima...