USC radiologists foster patient-centered care using 3D models

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 - Vinay A. Duddalwar, MD, FRCR
Vinay A. Duddalwar, MD, FRCR

Radiologists are putting patients at the center of care with the use of 3D modeling in surgical treatment planning.  By leveraging image overlay tools available on FUJIFILM Medical’s Synapse 3D solution, radiologists at Keck Hospital, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, are using volumetric imaging to generate 3D models of organs and other parts of the anatomy. Referring physicians and radiologists are using these 3D models to develop treatment plans, predict and prepare for complications during procedures and educate patients about their conditions prior to treatment.

Today, 3D models already have several clinical applications across the continuum of care, including creating prosthetics, individualized bio-printing of organs, transplantation and transcatheter aortic valve replacement planning. 1  3D prototypes can be rendered digitally for viewing on a monitor, overlaid on video or printed out as physical models. With video overlay, a segment of a video recording can be registered to the corresponding preoperative 3D-computed tomography (CT) image. 2

To develop a printed model, volumetric image datasets—such as CT or MRI—are segmented into structures of interest. These structures are then tessellated and outputted in the Standard Tessellation Language (STL) file format, a universally accepted format for 3D rendering and printing. An ever-growing variety of 3D printers can take the STL files and print a three dimensional physical object.

The use of 3D models in medical imaging is a logical extension of traditional image post-processing techniques. Fujifilm Medical supports clinicians in developing image datasets into models with Synapse 3D, an advanced visualization solution for multimodality image processing.  Fujifilm Medical’s Synapse 3D Clinical Application Suite is integrated into Synapse PACS, where the volumetric image datasets reside.

Synapse 3D includes a comprehensive base toolset, complete with automatic vessel segmentation and analysis algorithms, one-click measurement capabilities, masking segmentations, sector multiplanar reformations (MPR) and a fusion overlay tool and fusion viewer, enabling radiologists to overlay and co-register a series of images. Real-time collaboration between radiologists and referring physicians is supported through screen sharing technology on a 3D/4D viewer, where radiologists and referrers can manipulate and evaluate images across multiple planes using Synapse 3D.

3D models reshape renal cancer treatment

This year alone, renal cell and renal pelvis cancer have accounted for an estimated 63,920 new cases and 13,860 deaths in the United States.3 One of the standards of care for treating small localized renal tumors is robot-assisted laparoscopic partial nephrectomy, and preoperative imaging techniques, such as CT or MRI, are routinely performed to determine the tumor location, dimensions and charecterization.2 Increasingly, radiologists are leveraging image overlay techniques to create 3D models to help surgeons prepare for laparoscopic partial nephrectomy. Using these models, surgeons can track the kidney surface in real-time when applied to intraoperative video recordings and overlay the 3D models of the kidney, tumor (or stone) and collecting system.4

At Keck Hospital, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, radiologists scan an estimated 400 patients annually who present for a consultation for renal cancer surgery; around 300 of those patients eventually undergo surgery.  Radiologists and surgeons use Synapse 3D to develop virtual 3D models for the evaluation of renal masses and to develop treatment plans.

Radiologists use standard protocols in Synapse 3D to enhance the visualization of the mass and extract information that the urologist then uses. 

Synapse 3D allows the radiologist to overlay and fuse the images from phases one, two, three and four. Users can subtract the blood vessels or the collecting system from the kidney to better view the functioning parenchyma or blood vessels.  Different visualization streams can be configured to see everything, extract features or superimpose another, making the tumor transparent.

Case study no. 1

A recent patient presented with pain in the abdomen and blood in his urine.  After undergoing a single-phase CT scan at another center, he was referred to physicians at the USC Norris Comprehensive Cancer Center and Hospital, where he underwent a standard of care multiphase-CT scan.