Dual-room CT with a sliding gantry for intraoperative imaging: feasibility and workflow analysis of an interdisciplinary concept



Currently, intraoperative computed tomography (iCT) is a scarcely used technique in neurosurgery. It remains unclear whether this phenomenon is explained by unfavorable iCT-related workflows and/or a limited number of indications. We here analyzed workflows of an installed dual-room iCT (DR-iCT) as compared to surgical procedures lacking iCT. We compared infection rates, utilizations rates, and the spectrum of indications of DR-iCT with that of a previously used single-room iCT.


The study refers to a consecutive series of patients undergoing either single-room iCT (January 2014–August 2014) or DR-iCT (September 2014–July 2016). A further group undergoing surgery without iCT in the interconnected operating rooms represents the reference group. Workflow measurements and infection rates were calculated. Indications for iCT and utilization rates were compared for each of the devices. CT image quality was rated.


Application of DR-iCT led to a broader use of this technique as compared to the single-room device, which concerned in particular stereotactic neurosurgery. Accordingly, iCT utilization rates significantly increased (up to 50.8 ± 4.6 surgeries per month, p < 0.001). Workflow was slightly prolonged in case of DR-iCT imaging; the difference, however, was not statistically significant. Infections rates were low (range 0.0–0.17 infections per month) and not influenced by the utilization rate. Image quality of the DR-iCT was classified as very good in 34/43 evaluated microsurgical patients.


The use of DR-iCT enhances utilization rates with a broader field of indications for intraoperative imaging. Workflow measurements are not significantly prolonged. The technology is safe, and the imaging quality of modern devices can be expected to be good.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8


  1. 1.

    Nimsky C, Carl B (2017) Historical, current, and future intraoperative imaging modalities. Neurosurg Clin N Am 28(4):453–464

    Article  Google Scholar 

  2. 2.

    Lunsford LD, Kondziolka D, Bissonette DJ (1996) Intraoperative imaging of the brain. Stereotact Funct Neurosurg 66(1–3):58–64

    CAS  Article  Google Scholar 

  3. 3.

    Okudera H, Kobayashi S, Kyoshima K, Gibo H, Takemae T, Sugita K (1991) Development of the operating computerized tomographic scanner system for neurosurgery. Acta Neurochir 111(1–2):61–63

    CAS  Article  Google Scholar 

  4. 4.

    Shalit MN, Israeli Y, Matz S, Cohen ML (1982) Experience with intraoperative CT scanning in brain tumors. Surg Neurol 17(5):376–382

    CAS  Article  Google Scholar 

  5. 5.

    Schnell O, Morhard D, Holtmannspotter M, Reiser M, Tonn JC, Schichor C (2012) Near-infrared indocyanine green videoangiography (ICGVA) and intraoperative computed tomography (iCT): Are they complementary or competitive imaging techniques in aneurysm surgery? Acta Neurochir 154(10):1861–1868

    Article  Google Scholar 

  6. 6.

    Schichor C, Rachinger W, Morhard D, Zausinger S, Heigl TJ, Reiser M, Tonn JC (2010) Intraoperative computed tomography angiography with computed tomography perfusion imaging in vascular neurosurgery: feasibility of a new concept. J Neurosurg 112(4):722–728

    Article  Google Scholar 

  7. 7.

    Cuddy K, Khatib B, Bell RB, Cheng A, Patel A, Amundson M, Dierks EJ (2018) Use of intraoperative computed tomography in craniomaxillofacial trauma surgery. J Oral Maxillofac Surg 76(5):1016–1025

    Article  Google Scholar 

  8. 8.

    Sen AN, Fridley J, Sebastian S, Duckworth EAM (2017) Intraoperative computed tomography angiography: a novel completion imaging modality for carotid endarterectomy. Oper Neurosurg 13(6):739–745

    Article  Google Scholar 

  9. 9.

    Chang SS, Okamoto T, Tokunaga Y, Nakano T (2018) Intraoperative computed tomography navigation during thoracoscopic segmentectomy for small-sized lung tumors. Semin Thorac Cardiovasc Surg 30(1):96–101

    Article  Google Scholar 

  10. 10.

    Tonn JC, Schichor C, Schnell O, Zausinger S, Uhl E, Morhard D, Reiser M (2011) Intraoperative computed tomography. Acta Neurochir Suppl 109:163–167

    CAS  Article  Google Scholar 

  11. 11.

    Linsler S, Antes S, Senger S, Oertel J (2016) The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases. J Neurosci Rural Pract 7(4):598–602

    Article  Google Scholar 

  12. 12.

    Terpolilli NA, Rachinger W, Kunz M, Thon N, Flatz WH, Tonn JC, Schichor C (2015) Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography. J Neurosurg 124:1–9

    Google Scholar 

  13. 13.

    Ardeshiri A, Radina C, Edlauer M, Ardeshiri A, Riepertinger A, Nerlich A, Tonn JC, Winkler PA (2009) Evaluation of new radiolucent polymer head holder pins for use in intraoperative computed tomography. J Neurosurg 111(6):1168–1174

    Article  Google Scholar 

  14. 14.

    Butler WE, Piaggio CM, Constantinou C, Niklason L, Gonzalez RG, Cosgrove GR, Zervas NT (1998) A mobile computed tomographic scanner with intraoperative and intensive care unit applications. Neurosurgery 42(6):1304–1310 (discussion 1310–1311)

    CAS  Article  Google Scholar 

  15. 15.

    Uhl E, Zausinger S, Morhard D, Heigl T, Scheder B, Rachinger W, Schichor C, Tonn JC (2009) Intraoperative computed tomography with integrated navigation system in a multidisciplinary operating suite. Neurosurgery 64(5 Suppl 2):231–239 (discussion 239–240)

    Google Scholar 

  16. 16.

    Kim CS, Maxfield AZ, Foyt D, Rapoport RJ (2017) Utility of intraoperative computed tomography for cochlear implantation in patients with difficult anatomy. Cochlear Implants Int 19:1–10

    CAS  Google Scholar 

  17. 17.

    Zausinger S, Scheder B, Uhl E, Heigl T, Morhard D, Tonn JC (2009) Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine (Phila Pa 1976) 34(26):2919–2926

    Article  Google Scholar 

  18. 18.

    Eljamel MS, Mahboob SO (2016) The effectiveness and cost-effectiveness of intraoperative imaging in high-grade glioma resection: a comparative review of intraoperative ALA, fluorescein, ultrasound and MRI. Photodiagnosis Photodyn Ther 16:35–43

    Article  Google Scholar 

  19. 19.

    Mahboob S, McPhillips R, Qiu Z, Jiang Y, Meggs C, Schiavone G, Button T, Desmulliez M, Demore C, Cochran S, Eljamel S (2016) Intraoperative ultrasound-guided resection of gliomas: a meta-analysis and review of the literature. World Neurosurg 92:255–263

    Article  Google Scholar 

  20. 20.

    Dinevski N, Sarnthein J, Vasella F, Fierstra J, Pangalu A, Holzmann D, Regli L, Bozinov O (2017) Postoperative neurosurgical infection rates after shared-resource intraoperative magnetic resonance imaging—a single center experience with 195 cases. World Neurosurg 103:275–282

    Article  Google Scholar 

  21. 21.

    Wathen C, Kshettry VR, Krishnaney A, Gordon SM, Fraser T, Benzel EC, Modic MT, Butler S, Machado AG (2016) The association between operating room personnel and turnover with surgical site infection in more than 12000 neurosurgical cases. Neurosurgery 79(6):889–894

    Article  Google Scholar 

  22. 22.

    Lopez Pereira P, Diaz-Agero Perez C, Lopez Fresnena N, Las Heras Mosteiro J, Palancar Cabrera A, Rincon Carlavilla AL, Aranaz Andres JM (2017) Epidemiology of surgical site infection in a neurosurgery department. Br J Neurosurg 31(1):10–15

    Article  Google Scholar 

  23. 23.

    Black PM, Moriarty T, Alexander E III, Stieg P, Woodard EJ, Gleason PL, Martin CH, Kikinis R, Schwartz RB, Jolesz FA (1997) Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications. Neurosurgery 41(4):831–842 (discussion 842–845)

    CAS  Article  Google Scholar 

  24. 24.

    Nimsky C, Ganslandt O, Buchfelder M, Fahlbusch R (2006) Intraoperative visualization for resection of gliomas: the role of functional neuronavigation and intraoperative 1.5 T MRI. Neurol Res 28(5):482–487

    Article  Google Scholar 

  25. 25.

    Nimsky C, Ganslandt O, Hastreiter P, Wang R, Benner T, Sorensen AG, Fahlbusch R (2005) Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery. Neurosurgery 56(1):130–137 (discussion 138)

    Article  Google Scholar 

  26. 26.

    Li P, Qian R, Niu C, Fu X (2016) Impact of intraoperative MRI-guided resection on resection and survival in patient with gliomas: a meta-analysis. Curr Med Res Opin 33:1–28

    Google Scholar 

  27. 27.

    Jenkinson MD, Barone DG, Bryant A, Vale L, Bulbeck H, Lawrie TA, Hart MG, Watts C (2018) Intraoperative imaging technology to maximise extent of resection for glioma. Cochrane Database Syst Rev 1:CD012788

    Google Scholar 

  28. 28.

    Giordano M, Samii A, Lawson McLean AC, Bertalanffy H, Fahlbusch R, Samii M, Di Rocco C (2016) Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility. J Neurosurg Pediatr 19:1–8

    Google Scholar 

  29. 29.

    Ashour R, Reintjes S, Park MS, Sivakanthan S, van Loveren H, Agazzi S (2016) Intraoperative magnetic resonance imaging in skull base surgery: a review of 71 consecutive cases. World Neurosurg 93:183–190

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Markus Lenski.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lenski, M., Hofereiter, J., Terpolilli, N. et al. Dual-room CT with a sliding gantry for intraoperative imaging: feasibility and workflow analysis of an interdisciplinary concept. Int J CARS 14, 397–407 (2019). https://doi.org/10.1007/s11548-018-1812-9

Download citation


  • Intraoperative CT
  • Sliding gantry
  • Dual-room CT scanner
  • Computed tomography