title: Radio-guided sentinel lymph node identification by lymphoscintigraphy fused with an anatomical vector profile: clinical applications.
abstract: OBJECTIVE
  To develop a method to fuse lymphoscintigraphic images with an adaptable anatomical vector profile and to evaluate its role in the clinical practice.
  
  
  METHODS
  We used Adobe Illustrator CS6 to create different vector profiles, we fused those profiles, using Adobe Photoshop CS6, with lymphoscintigraphic images of the patient. We processed 197 lymphoscintigraphies performed in patients with cutaneous melanomas, breast cancer or delayed lymph drainage.
  
  
  RESULTS
  Our models can be adapted to every patient attitude or position and contain different levels of anatomical details ranging from external body profiles to the internal anatomical structures like bones, muscles, vessels, and lymph nodes. If needed, more new anatomical details can be added and embedded in the profile without redrawing them, saving a lot of time. Details can also be easily hidden, allowing the physician to view only relevant information and structures. Fusion times are about 85 s. The diagnostic confidence of the observers increased significantly. The validation process showed a slight shift (mean 4.9 mm).
  
  
  CONCLUSIONS
  We have created a new, practical, inexpensive digital technique based on commercial software for fusing lymphoscintigraphic images with built-in anatomical reference profiles. It is easily reproducible and does not alter the original scintigraphic image. Our method allows a more meaningful interpretation of lymphoscintigraphies, an easier recognition of the anatomical site and better lymph node dissection planning.
authors.affiliation: DIM, Unità di Medicina Nucleare-Radiodiagnostica, Università degli studi di Bari, Piazza G. Cesare, 11, 70124, Bari, Italy, artor.niccoliasabella@uniba.it.
authors.forename: A
authors.initials: A
authors.lastname: Niccoli Asabella
authors.forename: F
authors.initials: F
authors.lastname: Antonica
authors.forename: M A
authors.initials: MA
authors.lastname: Renna
authors.forename: D
authors.initials: D
authors.lastname: Rubini
authors.forename: A
authors.initials: A
authors.lastname: Notaristefano
authors.forename: A
authors.initials: A
authors.lastname: Nicoletti
authors.forename: G
authors.initials: G
authors.lastname: Rubini
mesh_terms: D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000191:economics / Q000379:methods* / Q000592:standards; D008198:Lymph Nodes / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D061305:Lymphoscintigraphy / Q000379:methods*; D009369:Neoplasms / Q000000981:diagnostic imaging; D012015:Reference Standards; D012984:Software