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Melchior C, Isfort P, Braunschweig T, Witjes M, Van den Bosch V, Rashad A, Egger J, de la Fuente M, Röhrig R, Hölzle F, Puladi B. Development and validation of a cadaveric porcine Pseudotumor model for Oral Cancer biopsy and resection training. BMC Med Educ 2024; 24:250. [PMID: 38500112 PMCID: PMC10949621 DOI: 10.1186/s12909-024-05224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The gold standard of oral cancer (OC) treatment is diagnostic confirmation by biopsy followed by surgical treatment. However, studies have shown that dentists have difficulty performing biopsies, dental students lack knowledge about OC, and surgeons do not always maintain a safe margin during tumor resection. To address this, biopsies and resections could be trained under realistic conditions outside the patient. The aim of this study was to develop and to validate a porcine pseudotumor model of the tongue. METHODS An interdisciplinary team reflecting various specialties involved in the oncological treatment of head and neck oncology developed a porcine pseudotumor model of the tongue in which biopsies and resections can be practiced. The refined model was validated in a final trial of 10 participants who each resected four pseudotumors on a tongue, resulting in a total of 40 resected pseudotumors. The participants (7 residents and 3 specialists) had an experience in OC treatment ranging from 0.5 to 27 years. Resection margins (minimum and maximum) were assessed macroscopically and compared beside self-assessed margins and resection time between residents and specialists. Furthermore, the model was evaluated using Likert-type questions on haptic and radiological fidelity, its usefulness as a training model, as well as its imageability using CT and ultrasound. RESULTS The model haptically resembles OC (3.0 ± 0.5; 4-point Likert scale), can be visualized with medical imaging and macroscopically evaluated immediately after resection providing feedback. Although, participants (3.2 ± 0.4) tended to agree that they had resected the pseudotumor with an ideal safety margin (10 mm), the mean minimum resection margin was insufficient at 4.2 ± 1.2 mm (mean ± SD), comparable to reported margins in literature. Simultaneously, a maximum resection margin of 18.4 ± 6.1 mm was measured, indicating partial over-resection. Although specialists were faster at resection (p < 0.001), this had no effect on margins (p = 0.114). Overall, the model was well received by the participants, and they could see it being implemented in training (3.7 ± 0.5). CONCLUSION The model, which is cost-effective, cryopreservable, and provides a risk-free training environment, is ideal for training in OC biopsy and resection and could be incorporated into dental, medical, or oncologic surgery curricula. Future studies should evaluate the long-term training effects using this model and its potential impact on improving patient outcomes.
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Affiliation(s)
- Claire Melchior
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, RWTH Aachen University, 52074, Aachen, Germany
- Institute of Pathology, Faculty of Medicine, Ludwig Maximilians University (LMU), 80337, Munich, Germany
| | - Max Witjes
- Department of Oral and Maxillofacial Surgery, UMCG Groningen, 9713, GZ, Groningen, The Netherlands
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Ashkan Rashad
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jan Egger
- Cancer Research Center Cologne Essen (CCCE), University Medicine Essen (AöR), 45147, Essen, Germany
- Institute of Artificial Intelligence in Medicine, Essen University Hospital, 45131, Essen, Germany
| | - Matías de la Fuente
- Chair of Medical Engineering, RWTH Aachen University, 52074, Aachen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. Author Correction: First validation of a model-based hepatic percutaneous microwave ablation planning on a clinical dataset. Sci Rep 2023; 13:18918. [PMID: 37919462 PMCID: PMC10622408 DOI: 10.1038/s41598-023-45924-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands.
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. First validation of a model-based hepatic percutaneous microwave ablation planning on a clinical dataset. Sci Rep 2023; 13:16862. [PMID: 37803064 PMCID: PMC10558472 DOI: 10.1038/s41598-023-42543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actual ablation ground truth from a clinical dataset in liver. The biophysical model uses a simplified formulation of heat deposition on the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined to assess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model prediction compared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculature shortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermal prediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be used as liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermal ablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate its integration into the clinical workflow.
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Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands.
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. Model-based hepatic percutaneous microwaveablation planning. First validation on a clinical dataset. Res Sq 2023:rs.3.rs-2781339. [PMID: 37131766 PMCID: PMC10153367 DOI: 10.21203/rs.3.rs-2781339/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actualablation ground truth from a clinical data set in liver. The biophysical model uses a simplified formulation of heat depositionon the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined toassess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model predictioncompared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculatureshortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermalprediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be usedas liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermalablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate itsintegration into the clinical workflow.
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Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, 52074, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, 52074, Germany
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Van den Bosch V, De Beukelaer F, Isfort P, Keil S, Kuhl CK, Bruners P, Pedersoli F. Long loop technique with bifemoral access as salvage technique for repositioning of dislodged port catheters. CVIR Endovasc 2022; 5:64. [PMID: 36512154 PMCID: PMC9748016 DOI: 10.1186/s42155-022-00341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Repositioning of dislocated port systems' catheters is usually performed with a pigtail catheter and/or a goose snare. In case of an inaccessible port catheter tip due to thrombosis, this classic approach may be not successful. For these cases, we describe a long loop bailout technique with bifemoral access. TECHNIQUE Via a right transfemoral access, a first attempt to reposition the dislodged port catheter using pigtail catheter and goose snare was performed. After an unsuccessful attempt and delineation of thrombosis of the catheter tip, the contralateral femoral vein was subsequently punctured and a sheath was placed. Through both vascular sheaths, pigtail catheter and goose wire were advanced distally to the catheter. The guidewire in the pigtail catheter was snared, thus creating a "Long loop" configuration. Pulling down both catheters simultaneously with improved stability allowed to detach the catheter tip from the vessel wall and replacement into the superior vena cava was possible. Refinement of catheter tip position was done using the goose snare. This technique was applied on 5 patients with dislodged port catheters in the jugular vein (2/5), the innominate vein (1/5), the subclavian vein (1/5) and the azygos vein (1/5) with a technical success of 100%. No complications were observed. CONCLUSION The Long loop technique can be used as salvage approach to reposition a dislodged catheter in case of failure with pigtail catheter and goose snare.
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Affiliation(s)
- Vincent Van den Bosch
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frédéric De Beukelaer
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Isfort
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Keil
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane K. Kuhl
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Bruners
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Federico Pedersoli
- grid.412301.50000 0000 8653 1507Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
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Van den Bosch V, Salim HS, Chen NZ, Stroosma O, Bruners P, Kuhl CK, Pedersoli F, Isfort P. Augmented Reality-Assisted CT-Guided Puncture: A Phantom Study. Cardiovasc Intervent Radiol 2022; 45:1173-1177. [PMID: 35750863 PMCID: PMC9307551 DOI: 10.1007/s00270-022-03195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Purpose To investigate the feasibility of a novel augmented reality system for CT-guided liver interventions and to compare it with free-hand interventions in a phantom setting. Methods and materials A newly developed augmented reality interface was used, with projection of CT-imaging in multiplanar reconstruction and live rendering of the needle position, a bull`s eye view of the needle trajectory and a visualization of the distance to the target. Punctures were performed on a custom-made abdominal phantom by three interventional radiologists with different levels of expertise. Time and needle placement accuracy were measured. Two-tailed Wilcoxon signed rank test (p < 0.05) was performed to evaluate intraparticipant difference. Results Intraparticipant puncture times were significantly shorter for each operator in the augmented reality condition (< 0.001 for the resident, < 0.001 for the junior staff member and 0.027 for the senior staff member). The junior staff member had an improvement in accuracy of 1 mm using augmented reality (p 0.026); the other two participants showed no significant improvement regarding accuracy. Conclusion In this small series, it appears that the novel augmented reality system may improve the speed of CT-guided punctures in the phantom model compared to the free-hand procedure while maintaining a similar accuracy. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03195-y.
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Affiliation(s)
- Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | | | - Njin-Zu Chen
- Philips Research Europe, Eindhoven, The Netherlands
| | | | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Van den Bosch V, Pedersoli F, Keil S, Neumann UP, Kuhl CK, Bruners P, Zimmermann M. Safety and efficacy of right portal vein embolization in patients with prior left lateral liver resection. Acta Radiol 2022; 63:727-733. [PMID: 33951926 DOI: 10.1177/02841851211014192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In patients with bilobar metastatic liver disease, surgical clearance of both liver lobes may be achieved through multiple-stage liver resections. For patients with extensive disease, a major two-staged hepatectomy consisting of resection of liver segments II and III before right-sided portal vein embolization (PVE) and resection of segments V-VIII may be performed, leaving only segments IV ± I as the liver remnant. PURPOSE To describe the outcome following right-sided PVE after prior complete resection of liver segments II and III. MATERIAL AND METHODS In this retrospective study, 15 patients (mean age = 60.4 ± 9.3 years) with liver metastases from colorectal cancer (n = 14) and uveal melanoma (n = 1) who were scheduled to undergo a major two-stage hepatectomy, were included. Total liver volume (TLV) and volume of the future liver remnant (FLR) were measured on pre- and postinterventional computed tomography (CT) scans, and standardized FLR volumes (ratio FLR/TLV) were calculated. Patient data were retrospectively analyzed regarding peri- and postinterventional complications, with special emphasis on liver function tests. RESULTS The mean standardized post-PVE FLR volume was 26.9% ± 6.4% and no patient developed hepatic insufficiency after the PVE. Based on FLR hypertrophy and liver function tests, all but one patient were considered eligible for the subsequent right-sided hepatectomy. However, due to local tumor progression, only 9/15 patients eventually proceeded to the second stage of surgery. . CONCLUSION Right-sided PVE was safe and efficacious in this cohort of patients who had previously undergone a complete resection of liver segments II and III as part of a major staged hepatectomy pathway leaving only segments IV(±I) as the FLR. .
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Affiliation(s)
- Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf P Neumann
- Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
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