title: Three-dimensional virtual reality simulation of periarticular tumors using Dextroscope reconstruction and simulated surgery: a preliminary 10-case study.
abstract: BACKGROUND
  Dextroscope® three-dimensional (3D) imaging has been extensively used to generate virtual reality (VR) workspaces for neurosurgery and laparoscopy, but few applications have been reported for orthopedic surgery. Here, we investigated orthopedic periarticular tumor surgery planning and anatomical characteristics using a Dextroscope.
  
  
  METHODS
  Patients undergoing surgery for periarticular tumors (n=10) between October 2008 and June 2010 were enrolled and presurgically subjected to computed tomography (CT), magnetic resonance imaging (MRI), and MRI angiography (MRI-A). Imaging data were transferred and integrated in a Dextroscope to produce a VR simulation. The presurgical 3D anatomical reconstructions and intraoperative anatomical characteristics (virtual vs. actual data) and surgical approach (virtual vs. actual situation) measurement and subjective appearance were compared.
  
  
  RESULTS
  Anatomical characteristics in the area of interest and tumor diameters in all 3 planes (superior-inferior, medial-lateral, and anteroposterior) were consistent between virtual and actual data (3.92±1.22, 1.96±0.53, and 1.73±0.44 vs. 3.92±1.13, 1.91±0.44, and 1.81±0.41; P=0.99, 0.24, and 0.09, respectively). However, the virtual surgical situations were inconsistent with the actual intraoperative situation in many cases, leading to complications. The resolutions of the original CT, MRI, and MRI-A images directly correlated with 3D simulation quality, with soft tissues most poorly represented. Tumor tissue imaging quality in 3D varied extensively by tumor type.
  
  
  CONCLUSIONS
  Anatomical structures of periarticular tumors can be reconstructed using the Dextroscope system with good accuracy in the case of simple fenestration, increasing treatment individualization, surgical competence level, and potentially reducing intraoperative complications. However, further specialization of VR tools for use in orthopedic applications that involve specialized tools and procedures, such as drilling and implant placement, are urgently need.
authors: Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland).
authors: JingSheng
authors: J
authors: Shi
authors: Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland).
authors: Jun
authors: J
authors: Xia
authors: Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland).
authors: YiBing
authors: Y
authors: Wei
authors: Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland).
authors: SiQun
authors: S
authors: Wang
authors: Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland).
authors: JianGuo
authors: J
authors: Wu
authors: Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland).
authors: FeiYan
authors: F
authors: Chen
authors: Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland).
authors: GangYong
authors: G
authors: Huang
authors: Department of Orthopedics, Huashan Hospital of Fudan University, Shanghai, China (mainland).
authors: Jie
authors: J
authors: Chen
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D014584:User-Computer Interface; D055815:Young Adult