Application of three-dimensional visualization technique in laparoscopic D3 radical resection of right colon cancer / 南方医科大学学报

OBJECTIVE@#To explore the clinical value of three-dimensional (3D) visualization technique in laparoscopic D3 radical resection of right colon cancer.@*METHODS@#We retrospectively analyzed the clinical data of 73 patients with right colon cancer undergoing laparoscopic D3 radical operation in our hospital between May, 2019 and March, 2021. Among these patients, 41 underwent enhanced CT examination with 3D visualization reconstruction to guide the actual operation, and 32 underwent enhanced CT examination only before the operation (control group). In 3D visualization group, we examined the coincidence rate between the 3D visualization model and the findings in surgical exploration of the anatomy and variations of the main blood vessels, supplying vessels of the tumor, and the tumor location, and the coincidence rate between the actual surgical plan for D3 radical resection of right colon cancer and the plan formulated based on the 3D model. The operative time, estimated blood loss, unexpected injury of blood vessels, number of harvested lymph nodes, mean time of the first flatus, complications, postoperative hospital stay and postoperative drainage volume were compared between the two groups.@*RESULTS@#The operative time was significantly shorter in 3D visualization group than in the control group (P < 0.05). The volume of blood loss, proportion of unexpected injury of blood vessel, the number of harvested lymph nodes, time of the first flatus, proportion of complications, postoperative hospital stay and postoperative drainage volume did not differ significantly between the two groups (P > 0.05). In the 3D visualization group, the 3D visualization model clearly displayed the shape and direction of the colon, the location of the tumor, the anatomy and variation of the main blood vessels and the blood vessels supplying the cancer, and showed a coincidence rate of 100% with the findings by surgical exploration. The surgical plan for D3 radical resection of right colon cancer was formulated based on the 3D model also showed a coincidence rate of 100% with the actual surgical plan.@*CONCLUSION@#The 3D visualization reconstruction technique allows clear visualization the supplying arteries of the tumor and their variations to improve the efficiency, safety and accuracy of laparoscopic D3 radical resection of right colon cancer.

Preliminary observation of deep cervical lymphatic-venous anastomosis under off-eyepiece 3D microscope to treat an elderly patient with cognitive impairment / 中华显微外科杂志

In September 2020, an elderly patient with cognitive impairment(CI) was admitted in Deparment of Microsurgery, Hangzhou Qiushi Hospital. The patient was in bed and could not answer correctly before surgery. The preoperative Minimum Mental State Examination(MMSE) score was 3(3/30) and the Montreal Cognitive Assessment (MoCA) score was 2(2/30). After completion of preoperative examinations, a 3D microscope combined with fluorescence tracing technique was used to perform deep cervical lymphatic-venous anastomosis at the bilateral cervical Va lymph nodes part: two anastomosis methods were performed, one was end to side anastomosis and the other was end to end anastomosis. The diameters of all anastomotic dilated lymphatic vessels were less than 0.2 mm, the diameters of end-to-side, end to end anastomotic veins were 0.6 mm and 0.2 mm. Short-term postoperative anti-inflammatory treatment was given and a long-term functional rehabilitation training was performed. There were no postoperative complications and the incision healed well. The MMSE scores were 8, 12, 14, 18 point, and the MoCA scores were 8, 9, 11, 13 point. At 3, 30, 90, 180 days after surgery, respectively. Basic cognitive function was restored at 9 months after surgery.

Clinical application of 3D visualization and mixed reality technique in surgical resection of renal tumor / 中华泌尿外科杂志

Objective:To investigate the clinical feasibility and effectiveness of 3D visualization and mixed reality technique in the partial nephrectomy of renal tumor, and to evaluate its role in the communication between doctors and patients.Methods:82 patients with renal tumors confirmed by imaging examination including 33 patients in our hospital and 49 patients admitted to the Beijing Cancer Hospital from June 2018 to December 2020, all of whom were single tumors without local or distant metastasis, and in line with the indications of endoscopic partial nephrectomy, but without other systemic serious diseases. These patients were randomly divided into observation group (n=41) and control group (n=41). Both groups were scanned with 64-slice spiral CT before operation, while the CT images in the observation group were generated by DICOM data, modeled by three-dimensional reconstruction software and uploaded to mixed reality glasses for the preoperative planning, doctor-patient communication and intraoperative guidance. In this study, 82 patients underwent laparoscopic partial nephrectomy. Questionnaires and scales were used to compare the awareness of disease and/or satisfaction with 3D visual images between the two groups. The intraoperative time of tumor detection, operative time, renal heat ischemia time and intraoperative blood loss in 2 groups were recorded to evaluate preoperative planning and intraoperative guidance. In addition, the recovery time of gastrointestinal function, indwelling time of urinary catheter, indwelling time of drainage tube in operation area, length of hospital stays after surgery and pathological type, as well as serum creatinine level and glomerular filtration rate (GFR) value in patients at 6 months after operation were used to evaluate the postoperative recovery.Results:Before surgery, the concentrations of serum creatinine in patients with the observation group and control group were (66.8±17.5) μmol/L and (70.5±13.7) μmol/L, and the GFR were (40.8±7.6) ml/min and (38.9±6.8) ml/min, respectively. All the 82 cases were operated successfully. The number of correct responses of patients in the observation group and control group about basic kidney physiology, kidney anatomy and surgical plan was (5 vs.4), (2 vs.1), (7 vs.4), the difference among which was statistically significant ( P<0.05). In the observation group, the points of patients in understanding their own kidney, disease, specific surgical plan, and risk of surgical complications were 9.5±1.61, 9.3±0.84, 9.7±0.53, and 8.5±2.21 respectively. The tumor detection time was (35.2±5.6) min, the operation time was (100.2±20.1) min, and the renal warm ischemia time was (22.7±8.6) min in the observation group, which was significantly shorter than that in the control group (43.2±6.7) min, (123.2±23.50) min, (33.2±7.8) min. However, there was no significant difference in the amount of bleeding (103.2±22.8 ml vs.112.5±19.5 ml), postoperative recovery time of gastrointestinal function (1.7±0.8 d vs.1.8±1.2 d), indwelling time of urinary catheter (3.9±1.6 d vs.4.2±1.0 d), indwelling time of drainage tube in operation area (4.6±1.3 d vs.4.9±1.7 d), length of hospital stays (6.9±1.5 d vs.7.2±1.3 d), pathological type, and the changes of serum creatinine (10.1±19.0 vs.9.6±11.3) and the amplitude of GRF (19.4±9.5 vs.18.5±10.7) fluctuation in the affected side 6 months after operation (19.4±9.5 vs.18.5±10.7) ( P>0.05). Conclusions:The application of 3D visualization and mixed reality technology in preoperative planning and intraoperative guidance of partial nephrectomy could improve patients' cognitive understanding of renal anatomy, tumor characteristics and surgical operation, and make doctor-patient communication smoother. It can reduce the risk of surgery to a certain extent, reduce the renal heat ischemia and the operation time, and remove the tumor more accurately.

Development and clinical application of 3D visualization-guided patient positioning system for radiotherapy / 中华放射医学与防护杂志

Objective:To develop a 3D visualization technology-assisted patient positioning system for radiotherapy and compare it with traditional patient positioning method for breast and pelvic radiotherapy.Methods:A total of 40 patients receiving radiotherapy in Changzhou No.2 People′s Hospital from June 2020 to April 2021 were selected for this study, including 20 patients with breast cancer and 20 patients with pelvic cancer.3D visualization reconstruction was carried out using the CT data of the patients for positioning. Then the 3D visualization models were integrated with the real treatment environment and were then shifted to the isocentral positions of accelerators through interactive operations. Based on this, the patients were actually positioned. Every week, all of the patients were firstly treated with traditional positioning, followed by 3D visualization-guided positioning. As a result, 240 times of positioning data of all patients were collected in three weeks. They were compared with the data of cone-beam CT(CBCT)-guided positioning, which served as the gold standard.Results:The absolute positioning errors of 3D visualization-guided positioning along x, y and z axes were (1.92±1.23), (2.04±1.16), and (1.77±1.37)mm, respectively for patients with breast cancer and were (2.07±1.08), (1.33±0.88), and (1.99±1.25)mm, respectively for patients with pelvic cancer. Compared with traditional positioning method , the accuracy of 3D visualization-guided positioning along x、 y, and z axes was increased by 38.83%, 52.40% and 33%, respectively for patients with breast cancer and was improved by 36.84%, 54.04% and 52.58% for patients with pelvic cancer, with all differences being statistically significant along y and z axes ( t=2.956-5.734, P< 0.05). Meanwhile, the error distribution of the two positioning method was statistically significant along in y axis for patients with breast cancer( χ2=7.481, P<0.05) and was statistically significant along each axis for patients with pelvic cancer( χ2=5.900, 6.415, 7.200, P<0.05). Conclusions:The positioning method guided by 3D visualization technology can effectively improve the positioning accuracy of patients with breast cancer and patients with pelvic cancer and is of value in potential clinical application.

Prospects for 3d printing in the treatment of cerebral aneurysm / 中国组织工程研究

BACKGROUND: Interventional treatment can also be used as a palliative treatment for patients who cannot be surgically removed. However, the positioning of the lesion at the beginning of the operation or the catheter during the interventional treatment can only be accurately and clearly displayed through the two-dimensional image, and is related to the operator’s own experience and understanding of the image. The 3D printing model is a physical model with high simulation and individualized features, and has the advantages of individualization and precision in the medical field. It is currently widely used in orthopedics, oral and maxillofacial surgery, but the application in the treatment of craniocerebral aneurysms is rarely reported. OBJECTIVE: To summarize the classification and treatment status of cerebral aneurysms, and to prospect the application prospect of 3D printing technology in the treatment of cerebral aneurysms. METHODS: The authors retrieved CNKI, WanFang, PubMed, and EI database. The search terms were “cerebral aneurysm, clinical classification, treatment, 3D printing”. A total of 96 relevant literatures were retrieved, and 51 articles were summarized according to the inclusion and exclusion criteria. Specifically, it included the classification of cerebral aneurysms, craniotomy and interventional therapy, and the application status of 3D printing technology. RESULTS AND CONCLUSION: At present, the treatment methods of cerebral aneurysms commonly used in clinical practice have their own advantages and limitations. In this case, 3D visualization and 3D printing technology are proposed, which is an important supplement for the clinical treatment of patients with cerebral aneurysms. It can display organ anatomy and spatial structure more intuitively and accurately through operations such as enlargement, rotation and transparency. At the same time, it can accurately locate the aneurysm site, calculate the aneurysm size and volume, and define the aneurysm morphology. This is significant in preoperative diagnosis, planning of surgery, precise operation during surgery, and improvement of surgical success rate for the brain aneurysm. Simultaneously, the solid model of 3D printing is also widely used in the aspects of disease communication and training of resident surgical operations. By summarizing the research progress of 3D printing technology in the treatment of cerebral aneurysms, we have a clearer understanding of the application of 3D visualization and 3D printing technology. Whether it is combined with fluid mechanics for hemodynamic research or refined treatment based on existing treatment schemes, it has promoted the development of clinical research.

Multi-view autostereoscopic system for 3D visualization in anatomy

Abstract Introduction The use of 3D imaging in the medical field has proven to be a benefit to doctors when diagnosing patients. As for different medical applications, 3D visualization systems have advantages in terms of a better spatial understanding of anatomical structures, better performance of tasks that require high level of dexterity, increased learning performance, and improved communications with patients or between doctors. Methods In this technical report, we show how to employ a multi-view autostereoscopic system to provide 3D images without any special glasses or equipment, describing a new way to obtain 3D visualization using sets of 2D images instead of real volumetric data such as magnetic resonance imaging (MRI) or computed tomography (CT). We also propose an application of the images in neuroanatomy. Results We obtained three-dimensional images of anatomical parts for visualization without glasses with resolution of 336 × 210 pixels'. Conclusion The proposed method was able to generate three-dimensional high-resolution images and has great potential to be used in various areas such as anatomy and physiological studies.

The primary exploration on the value of 3D visualization technique in the precise surgery for complex sacra tumor / 中国医学装备

Objective: To investigate the application value of 3D visualization technique in the precise surgery for complex sacra tumor. Methods: A 59-year-old female patient with the sacrum occupying for half a month was enrolled in the research. And then the original data of digital imaging and communication in medicine (DICOM), that were obtained through CT and MRI, were imported in computer to reconstruct 3D spatial model. Results: The reconstructive model that used 3D technique can not only clearly display the size of sacral tumor, but also reflect the anatomic morphology, the blood supply of tumor and the relationship between tumor and surrounding tissues. Under its guidance, the tumor could be completely removed, and the surrounding normal organs and nerve roots could be preserved as much as possible. Besides, the operation time was greatly decreased and the amount of bleeding was reduced. Conclusion: The application of 3D visualization technique in the surgical treatment for sacral tumor can enhance the safety of the tumorectomy of sacral tumor, and accelerate the operation speed, and increase the accuracy of operation, and protect vital organs and nerves, thus preserve the corresponding physiological function. Therefore, it has great application prospect in the precisely surgical treatment of spinal surgery.

3D visualization assisted proximal femoral nail anti-rotation surgery in the treatment of elderly intertrochanteric fracture / 局解手术学杂志

Objective To investigate the application of 3 D visualization (3 DV) assisted proximal femoral nail anti-rotation (PFNA) surgery in the treatment of elderly intertrochanteric fracture (ITF).Methods Totally 11 cases of elderly unstable ITF were treated with 3DV assisted PFNA fixation surgery.All these patients were examined with multi-row spiral CT volume scan,and the anatomical data of Dicom was reconstructed through M3 D software.Computer aided design (CAD) was performed based on 3 D reconstruction data,including anatomical data measurement,fracture reduction simulation,and proximal femoral head nail (PFNA) implant parameter design.And the CAD data were showed by S-3DV system during operation to guide the operation.Time of operation,intra-operative blood lose,post-operative drainage volume,hospital stay time and Harris hip score were recorded and compared to the non-3DV assisted PFNA procedure.Results In 3 DV-PFNA surgery,there was no significant difference between the preoperative planned average PFNA size and the implanted average PFNA size (P ＞ 0.05).Compared to the non-3DV-PFNA surgery,3 DV-PFNA surgery has less intra-operative blood lose and post-operative drainage volume,shorter time of preoperative traction reduction and operation (P ＜ 0.05).Harris hip function score of 3 DV-PFNA surgery was better than the conventional surgery 1 week after operation,and there was no significant difference in VAS score I month after operation.The 11 cases treated with 3DV-PFNA technology were healed well,and the rate of complications was lower than the conventional surgery.Conclusion 3DV technique can show accuracy CAD model of ITF,which may play an important role to improve efficiency and accuracy of PFNA surgery.

Application of three dimensional visualization techniques in the research of hepatic venous anatomy / 中华肝胆外科杂志

Hepatic veins as the only hepatic drainage veins are the important functional part of liver anatomy in the field of surgery.With the development of imaging technology,especially the application of three-dimensional visualization technology,it can provide precise and comprehensive information in the study of hepatic veins.And thus this paper comprehensively reviewed the recent researches on the three dimensional visualization technology for observign the hepatic veins.

The Application of 3D Orthopedic Doctor-patient Communication Software / 中国医学伦理学

This paper expounded the development situation of doctor -patient communication software , from two aspects of the server and the client introduces the main functions of the 3D orthopaedic doctor -patient commu-nication software , discussed emphatically the main role , including: improving the efficiency of doctor -patient communication;improving the quality of medical services;improving the patients′satisfaction degree .

Digital 3D anatomical modeling of the mandible with full teeth / 解剖学报

Objective To study and establish a high quality digital 3D anatomical modeling of the mandible with full teeth.Methods A set of accurate digital models of standard anatomical specimens of mandibular teeth were obtained by laser scanning, and the 3D mandible model was reconstructed by CT scan data;then, a registration deformation method based on the geometry and image anatomical landmark was employed to do the registration of each tooth to the mandible model, and finally the tooth enamel , dentin, periodontal ligament were generated .Results A high quality digital 3D anatomical modeling of the mandible with full teeth was built , each tooth had detail crown and whole root , the distinction between the enamel , dentin, periodontal ligament , and any anatomical regions can be zoomed and rotately displayed . Conclusion The digital 3D anatomical modeling of the mandible with full teeth has realistic 3D imaging view and convenient teaching-learning function , and has tremendous apllication futures in the stomatology , maxillofacial and other medical departments .

Fusão 3D de imagens de MRI/CT e termografia / 3D image fusion using MRI/CT and infrared images

INTRODUÇÃO: A termografia por imagem infravermelha (IR) é uma técnica para diagnóstico não-invasiva que permite a avaliação e quantificação de variações de temperatura na superfície da pele. Apesar de fornecer informações significativas para auxiliar no diagnóstico médico, esta técnica não permite avaliar det alhes anatômicos da região sendo analisada. Este artigo apresenta uma nova metodologia para realizar a fusão entre diferentes modalidades de imagens, tais como ressonância magnética (MRI) ou tomografia computadorizada por raios X (CT), juntamente com imagens de termografia infravermelha. MÉTODOS: Para a construção do modelo 3D, primeiramente são adquiridas as imagens por ressonância magnética (MRI) ou tomografia computadorizada (CT) e um conjunto de imagens térmicas da região de interesse. Em seguida, realiza-se o registro utilizando as projeções 2D (dos planos tomográficos) com as imagens térmicas. Após o registro, as imagens térmicas são combinadas e projetadas sobre o modelo 3D das imagens de MRI ou CT. RESULTADOS: O resultado é uma imagem 3D que combina informação de duas modalidades de imagens médicas diferentes. A combinação dessas duas modalidades de imagens médicas disponibiliza uma nova técnica de imagem 3D que agrupa informações anatômicas (MRI ou CT) e funcionais (variações de temperatura na superfície do corpo). CONCLUSÃO: Os resultados obtidos até o momento com essa nova metodologia indicam que ela pode auxiliar em diagnósticos médicos.

INTRODUCTION: Infrared (IR) thermal imaging is a non-invasive and diagnostic technique that allows evaluation and quantification based on the temperature changes of the skin surface. It provides significant information for clinical diagnosis; however this technique does not present the anatomical details of the region under inspection. In this work, it is presented an innovative image fusion method between different imaging modalities, such as magnetic resonance images (MRI) or X-ray computed tomography (CT), together with IR thermal images. METHODS: Firstly, in order to build the 3D model, the MRI or CT images and the IR thermal images (from the region of interest) are acquired. Then, based on the tomographic planes (image slices), the 2D projections are generated, and the IR images are registered accordingly. Next, the already registered IR set of images are combined and projected over the 3D MRI or CT model. RESULTS: The result is a 3D fused image that combines the information contents from the two different medical imaging modalities. The combination of these two medical imaging modalities offers a new 3D imaging technique that combines anatomical (MRI or CT) and functional (the body's surface temperature) information. CONCLUSION: The results obtained up to now with this new methodology indicate that it can aid in medical diagnosis.

Multislice CT Virtual Intravascular Endoscopy for Assessing Pulmonary Embolisms: a Pictorial Review

Multislice CT has been widely used in clinical practice for diagnosing cardiovascular disease due to its reduced invasiveness and its high spatial and temporal resolution. As a reliable alternative to conventional pulmonary angiography, multislice CT angiography has been recognized as the first line technique for detecting and diagnosing pulmonary embolism. A pulmonary embolism located in the main pulmonary artery, as well as being located in the segmental branches, can be accurately detected with multislice CT imaging, and especially with the use of 16- and 64-slice CT scanners. Visualization of pulmonary embolisms has traditionally been limited to 2D, multiplanar reformation and the 3D external surface visualizations. In this pictorial review, we present our experience of using 3D virtual intravascular endoscopy to characterize and evaluate the intraluminal appearance of pulmonary embolisms in a group of patients who were suspected of having pulmonary embolism and who were undergoing multislice CT angiography. We expect that the research findings from this study will provide insight into the extent of disease and the luminal changes to the pulmonary arteries that are due to the presence of thrombus, and so monitoring of the progress of disease and predicting the treatment outcome can well be achieved.

Development of three dimensional measuring program with frontal and lateral cephalometric radiographs: Part 2. 3-D visualization and measurment program for maxillofacial structure

To establish systematic diagnosis and treatment planning of dentofacial deformity patient including facial asymmetry or hemifacial microsomia patient, comprehensive analysis of three dimensional structure of the craniofacial skeleton is needed. Even though three dimensional CT has been developed, landmark identification of the CT is still questionable. In recent, a method for correcting cephalic malpositioning that enables accurate superimposition of the landmarks in different stages without using any additional equipment was developed. It became possible to compare the three-dimensional positional change of the maxillomandible without invasive procedure. Based on the principle of the method, a new program was developed for the purpose of diagnosis and treatment planning of dentofacial deformity patient via three dimensional visualization and structural analysis. This program enables us to perform following menu. First, visualization of three dimensional structure of the craniofacial skeleton with wire frame model which was made from the landmarks observed on both lateral and frontal cephalogram. Second, establishment of midsagittal plane of the face three dimensionally, with the concept of "the plane of the best-fit". Third, examination of the degree of deviation and direction of deformity of structure to the reference plane for the purpose of establishing surgical planning. Fourth, simulation of expected postoperative result by various image operation such as mirroring, overlapping.

3D Visualization of 2D CT Bone Image Using FSTB Algorithm / 대한의료정보학회지

In this paper, we propose 2D segmentation algorithm for 3D visualization using CT bone images. Kmeans algorithm and thresholding method are traditional methods that can detect human bone. But the noise appeared on segmented images generated by both Kmeans algorithm and thresholding method. To detect bone cluster, the two assumptions are considered, they are as follows; first, pixels that have high intensity can be merged into bone cluster. Secondly, because a bone cluster consists of large or small group, the ambiguous pixels can be merged into bone cluster by estimating segmentation function. With the proposed FSTB(Flexible Segmentation To Boundary) algorithm the noise didn't appeared on segmented CT bone images and the algorithm carried out effective segmentation to the ambiguous pixels.

Detection and 3D Reconstruction of Brain from MR Images / 대한의료정보학회지

In this paper, we propose a brain detection algorithm of cross-sectional images through a 3D volume. The proposed brain detection algorithm uses several steps. They are as follows; In the first step, the standard value and downward from input image data are removed. in the second step, the pixels with maximum intensity are removed but undesirable many small areas were appeared as by-products. In order to detect brain, these small areas need to be removed. In the third step, many small areas are removed by masking but some small areas still remained. In the fourth step, they are removed using three-dimensional connectivity. The proposed algorithm was applied to real human MRI data and the brain area was successfully detected.