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Software assistance for planning of RF-ablation and oncological resection in liver surgery

: Zidowitz, S.; Bourquain, H.; Hansen, C.; Rieder, C.; Weihusen, A.; Prause, G.; Peitgen, H.-O.


Vander Sloten, J. ; International Federation for Medical and Biological Engineering -IFMBE-:
4th European Conference of the International Federation for Medical and Biological Engineering, ECIFMBE 2008. Vol.1 : 23 - 27 November 2008, Antwerp, Belgium
Berlin: Springer, 2009 (IFMBE proceedings 22)
ISBN: 978-3-540-89207-6
ISBN: 978-3-540-89208-3
International Federation for Medical and Biological Engineering (European Conference ECIFMBE) <4, 2008, Antwerp>
Fraunhofer MEVIS ()
medical image computing; risk analysis; computer-assisted diagnosis; radiofrequency ablation; liver surgery

Computational support in intervention planning promises to support the subjective interpretation of data with reproducible measurements. Moreover, it is possible to develop and apply models that provide additional information which is not directly visible in the data. Based on computertomography multi-slice images of the liver, the planning software developed by MeVis Research offers tools to evaluate different interventional strategies preoperatively. In identifying patient individual risks, an optimized interventional plan is developed. In radiofrequency ablation of liver tumors, the treatment success highly depends on an effective placement of the radiofrequency applicators into the tumor to achieve sufficient coagulative necrosis. Beside tumor size and shape, the cooling effects of surrounding vessels are taken into account for a numerical estimation of the accessible thermal destruction. Based on this information, an optimized positioning can be obtained. In case of the surgical resection, removing the tumor together with a safety margin from the liver, requires transsection of local vascular structures that are supplying or draining a dedicated liver region. The identification and quantitative assessment of these regions, which are functionally endangered, guides the preoperative evaluation of surgical strategies. Subsequently proper visualizations of the planning data help to identify critical structures, and allow for a better control of the intraoperative situation. The planning data are matched with images from intraoperative ultrasound, and the aligned data are displayed in the operating theatre on monitors, which are placed directly the table. Moreover, an intraoperative adaption of the surgical planning is addressed: In oncologic liver surgery, additional tumors that were not visible in the preoperative images are often found during the intervention. With such findings, the resection strategy must be updated or completely revised. The planning software allows for an automated adaption of the surgical planning. The aim is to provide surgeons with an efficient tool for the quantitative assessment of planning, which is integrated in the workflow of oncologic liver interventions. To provide a meaningful procedural support of the surgical workflow, the cognitive needs of the surgeons have to be taken into account.