Clinical Orthopaedics and Related Research

, Volume 466, Issue 10, pp 2533–2541 | Cite as

Image Fusion for Computer-assisted Bone Tumor Surgery

  • Kwok Chuen Wong
  • Shekhar Madhuker Kumta
  • Gregory Ernest Antonio
  • Lung Fung Tse
Multimedia Article

Abstract

The fusion of computed tomography and magnetic resonance images is a software-dependent processing technique that enables one to integrate and analyze preoperative images for planning complex musculoskeletal tumor resections. By integrating various imaging modalities into one imaging data set we may facilitate preoperative image analysis and planning of navigation computer-assisted bone tumor resection and reconstruction. We performed image fusion for computer-assisted tumor surgery in 13 consecutive patients, seven males and six females, with a mean age of 35.8 years (range, 6–80 years). Visual verification of fused images was accurate in all patients. The mean time for image fusion was 30.6 minutes (range, 8–80 minutes). After intraoperative registration, all tumor resections were performed as planned preoperatively under navigation image guidance. Resections achieved after navigation resection planning were validated by postoperative CT or resected specimens in seven patients. Histologic examination of all resected specimens showed tumor-free margins in patients with bone sarcoma. The fusion of computed tomography and magnetic resonance imaging has the potential to enhance computer-assisted bone tumor surgery. The fusion image, when combined with surgical navigation, helps surgeons reproduce a preoperative plan reliably and may offer substantial clinical benefits.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Image Fusion Malignant Peripheral Nerve Sheath Tumor Giant Cell Tumor Navigation Software Intralesional Excision 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Eric Wai-kin Ng and Keith Kam-shing Lee (ACAOS-ITAV team, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong), for setup of the navigation system and documentation of operative procedures; Ulrich G. Buehner and Dr. Sarvestani Amir (R&D, Computer Assisted Applications, Stryker Navigation, Freiburg, Germany) for their support with use of the cranial navigation software; and Dr. Paul Unwin and the design team (Stanmore Implants Worldwide Ltd, Centre for Biomedical Engineering, Royal National Orthopaedic Hospital, Middlesex, UK) for the CAD custom tumor prosthesis. We also appreciate the assistance of Prof. Martin C. M. Wong and Man-ho Lee (Department of Rapid Prototyping & Tooling Unit, Hong Kong Polytechnic University) in use of the CAD software.

Supplementary material

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Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Kwok Chuen Wong
    • 1
  • Shekhar Madhuker Kumta
    • 1
  • Gregory Ernest Antonio
    • 2
  • Lung Fung Tse
    • 1
  1. 1.Department of Orthopaedics and TraumatologyThe Chinese University of Hong Kong, Prince of Wales HospitalShatinHong Kong
  2. 2.Department of Diagnostic Radiology and Organ ImagingThe Chinese University of Hong Kong, Prince of Wales HospitalShatinHong Kong

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