title: Neurosurgical simulation by interactive computer graphics on iPad.
abstract: OBJECTIVE
  Presurgical simulation before complicated neurosurgery is a state-of-the-art technique, and its usefulness has recently become well known. However, simulation requires complex image processing, which hinders its widespread application. We explored handling the results of interactive computer graphics on the iPad tablet, which can easily be controlled anywhere.
  
  
  METHODS
  Data from preneurosurgical simulations from 12 patients (4 men, 8 women) who underwent complex brain surgery were loaded onto an iPad. First, DICOM data were loaded using Amira visualization software to create interactive computer graphics, and ParaView, another free visualization software package, was used to convert the results of the simulation to be loaded using the free iPad software KiwiViewer.
  
  
  RESULTS
  The interactive computer graphics created prior to neurosurgery were successfully displayed and smoothly controlled on the iPad in all patients. The number of elements ranged from 3 to 13 (mean 7). The mean original data size was 233 MB, which was reduced to 10.4 MB (4.4% of original size) after image processing by ParaView. This was increased to 46.6 MB (19.9%) after decompression in KiwiViewer. Controlling the magnification, transfer, rotation, and selection of translucence in 10 levels of each element were smoothly and easily performed using one or two fingers. The requisite skill to smoothly control the iPad software was acquired within 1.8 trials on average in 12 medical students and 6 neurosurgical residents.
  
  
  CONCLUSIONS
  Using an iPad to handle the result of preneurosurgical simulation was extremely useful because it could easily be handled anywhere.
authors.affiliation: Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan. kskmaru-tky@umin.ac.jp.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Maruyama
authors.affiliation: Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Kin
authors.affiliation: Department of Clinical Information Engineering, The University of Tokyo Graduate School of Engineering, Tokyo, Japan.
authors.forename: Toki
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Suematsu
authors.affiliation: Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Gomyo
authors.affiliation: Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Noguchi
authors.affiliation: Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Motoo
authors.initials: M
authors.lastname: Nagane
authors.affiliation: Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D003196:Computer Graphics; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D061145:Microvascular Decompression Surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011859:Radiography; D012984:Software; D013238:Stereotaxic Techniques; D055815:Young Adult
keywords: Interactive computer graphics; Neurosurgery; Simulation; iPad