Advanced Visualization Makes the Cut: Adding a New Perspective to Surgery

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A Segmentation, Analysis, and Tracking module is used to view images in their present state as well as over the course of time. Lesion area and volume are automatically calculated and displayed. Source: TeraRecon.

Although much of the focus on advanced visualization in medical imaging has been on its use in diagnostic interpretation, one of the technology’s strongest clinical roles may be its utilization by clinicians in planning interventional treatments. In addition to improving the quality of patient care, the applications foster even stronger collaboration between radiology services and surgical units.

Vijay K. Maker, MD, is an enthusiastic adopter of advanced visualization tools in his surgical practice. “The software I’m using now (Vitrea, Vital Images) has dramatically helped in planning complex surgery,” he says.

Maker, professor of surgery and family practice at Rush Medical School, chairman of the department of surgery at Illinois Masonic Hospital and program director of general surgery residency for the University of Illinois in Chicago, is a busy practitioner with a full clinical and didactic schedule. The use of advanced visualization software enables him to more efficiently, and effectively, plan surgeries.

“The use of 3D visualization preoperatively helps plan the surgery,” he says. “I can literally simulate the entire surgical procedure preoperatively.”

He finds that the ability to see pathology, in addition to the information from a radiologist’s diagnostic report, enables him to fine tune his surgical plan.

“Being able to see the diagnosis with my own eyes in 3D, rather than just reading it from a radiologist’s report, has helped in my surgical planning,” he says. “Radiologists are trained to take three separate images [coronal, axial and sagittal slices] and put them together in their head. Other clinicians don’t have that training, so looking at images in 3D really helps us.”

Maker says he has used advanced visualization reformations in almost all aspects of his practice as a general surgeon. He notes that it is particularly helpful in complex vascular interventions as well as in oncologic surgery in the liver and pancreas as well as sarcomas.

Interventional radiology may just as easily be called “image-guided surgery.” Although the practitioners of interventional radiology are comfortable and confident at delivering reports from diagnostic images, they are equally as skilled at conducting image-guided interventional procedures.

Constantino S. Peña, MD, interventional radiologist and the medical director of vascular imaging at the Baptist Cardiac & Vascular Institute in Miami, says that advanced visualization technology is a well-used tool in his practice, too.

“I think it aids what we do everyday,” he says. “Before we start our day, we get together and review all the different cases that we will handle. We discuss the clinical information, and then we go over the imaging that’s available. Advanced imaging technologies (iNtuition, TeraRecon) give us a better feel for how we’re going to treat our patients. Often, we’ll display those reformations in the procedure suite.”

Peña says that advanced visualization tools are helpful in all the different types of procedures performed in his practice. “Where we really find the value is in complex procedures,” he says. “Although it’s important and useful for placing a G-Tube—which is a non-vascular interventional procedure—it’s also helpful to evaluate liver segments for a possible portal vein or hepatic vein embolization.”

Peña says he tailors his image reformations to the type of patient procedure he will be performing. “The volume-rendered images are very pretty, very nice pictures. A lot of times, those can give you a global evaluation of what is going on [with a particular pathology]. With our vascular work, we rely on a lot of MIPS [maximum intensity projections] to help us evaluate things such as the amount of calcium and lumen of a vessel and curved-planar reformations to help us evaluate the length of a stenosis or length of an artery.”

Another great seaport up the coast from Miami is home to the practice of interventional radiologist Neil J. Halin, DO. Halin, an assistant professor at Tufts University School of Medicine in Boston, and its chief of cardiovascular and interventional radiology, says that advanced visualization technology is used every day in his department. “We use it [Visage CS, Visage Imaging] for everything from routine