title: Integration of oncologic margins in three-dimensional virtual planning for head and neck surgery, including a validation of the software pathway.
abstract: OBJECTIVE
  Three-dimensional (3D) virtual planning of reconstructive surgery, after resection, is a frequently used method for improving accuracy and predictability. However, when applied to malignant cases, the planning of the oncologic resection margins is difficult due to visualisation of tumours in the current 3D planning. Embedding tumour delineation on a magnetic resonance image, similar to the routinely performed radiotherapeutic contouring of tumours, is expected to provide better margin planning. A new software pathway was developed for embedding tumour delineation on magnetic resonance imaging (MRI) within the 3D virtual surgical planning.
  
  
  METHODS
  The software pathway was validated by the use of five bovine cadavers implanted with phantom tumour objects. MRI and computed tomography (CT) images were fused and the tumour was delineated using radiation oncology software. This data was converted to the 3D virtual planning software by means of a conversion algorithm. Tumour volumes and localization were determined in both software stages for comparison analysis. The approach was applied to three clinical cases.
  
  
  RESULTS
  A conversion algorithm was developed to translate the tumour delineation data to the 3D virtual plan environment. The average difference in volume of the tumours was 1.7%.
  
  
  CONCLUSIONS
  This study reports a validated software pathway, providing multi-modality image fusion for 3D virtual surgical planning.
authors: Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: j.kraeima@umcg.nl.
authors: Joep
authors: J
authors: Kraeima
authors: Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: r.h.schepers@umcg.nl.
authors: Rutger H
authors: RH
authors: Schepers
authors: Department of Radiology, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: p.m.a.van.ooijen@umcg.nl.
authors: Peter M A
authors: PM
authors: van Ooijen
authors: Department of Radiation Oncology, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: r.j.h.m.steenbakkers@umcg.nl.
authors: Roel J H M
authors: RJ
authors: Steenbakkers
authors: Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: j.l.n.roodenburg@umcg.nl.
authors: Jan L N
authors: JL
authors: Roodenburg
authors: Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: m.j.h.witjes@umcg.nl.
authors: Max J H
authors: MJ
authors: Witjes
mesh_terms: D000465:Algorithms; D000564:Ameloblastoma / Q000000981:diagnostic imaging / Q000601:surgery; D000818:Animals; D002417:Cattle; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007573:Jaw Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008339:Mandibular Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D000072662:Margins of Excision; D008441:Maxillary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D023421:Models, Animal; D064847:Multimodal Imaging / Q000379:methods; D010347:Patient Care Planning; D015203:Reproducibility of Results; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden; D014584:User-Computer Interface
keywords: 3D planning; Data fusion; Free-flap reconstruction; Oncologic margins