Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Head Neck. 2019 Sep;41(9):3372-3382. doi: 10.1002/hed.25864. Epub 2019 Jul 9.
The image-guided operating room (OR) is an emerging standard for dealing with complex cases in many surgical disciplines including neurosurgery, thoracic surgery, maxillofacial trauma, and orthopedic surgery. Its use in head and neck oncological surgery is not well established. The primary aim of this study was to assess the image quality of cone-beam CT (CBCT) under real clinical conditions. The secondary aim was to assess the effect on surgical performance and decision making.
Intraoperative 3D imaging was performed using a CBCT capable C-Arm mounted on a multi-axis robot (Siemens Zeego) in the image-guided OR. All patients had immediate preoperative imaging taken with further intraoperative imaging performed as required. Ten initial patients, comprising 28 intraoperative scans, were used for questionnaire-based image reviews conducted with experienced head and neck clinicians. Scans were assessed for aspects of both image quality and clinical utility, on separate 5-point Likert scales (1-5).
The median rating for bony detail was 4 out of 5. Vascular detail was increased (P < 10 ) from 1 to 3 with the use of IV contrast (region of interest CT# was 284 HU [SD, 47 HU]). Images were rated as 4 for freedom from artifact. Soft tissue definition was 2, with no significant improvement (P = .2) with the addition of IV iodinated contrast. Surgeons rated the greatest clinical utility (4) for the CBCT when assessing postreconstruction imaging of a complex case.
The image quality of CBCT in the image-guided OR is good for bony detail and complex oncological reconstructions in the head and neck setting but probably has limited benefit for intraoperative soft tissue delineation. Future studies must also focus on clinical outcomes to help demonstrate the value of the image-guided OR.
影像引导手术室（OR）是许多外科领域（包括神经外科、胸外科、颌面创伤和骨科）处理复杂病例的新兴标准。其在头颈部肿瘤外科中的应用尚未得到充分确立。本研究的主要目的是评估在真实临床条件下锥形束 CT（CBCT）的图像质量。次要目的是评估其对手术性能和决策的影响。
在影像引导 OR 中，使用安装在多轴机器人上的具有 CBCT 功能的 C 臂（西门子 Zeego）进行术中 3D 成像。所有患者均在术前即刻进行影像学检查，并根据需要进行术中进一步影像学检查。10 例初始患者（28 例术中扫描）用于基于问卷的影像回顾，由经验丰富的头颈部临床医生进行。使用 5 分制（1-5）的独立 Likert 量表分别评估扫描的图像质量和临床实用性。
骨细节的中位数评分为 4 分（满分 5 分）。使用 IV 造影剂后，血管细节从 1 分增加到 3 分（感兴趣区域 CT#为 284 HU[标准差，47 HU]）（P < 10）。图像评分为 4 分，无明显伪影。软组织定义为 2 分，IV 碘化造影剂添加后无显著改善（P =.2）。当评估复杂病例的重建后图像时，外科医生对 CBCT 的临床实用性（4 分）评价最高。
在头颈部肿瘤外科中，影像引导 OR 中的 CBCT 图像质量对于骨细节和复杂的肿瘤重建效果良好，但对于术中软组织描绘可能益处有限。未来的研究还必须关注临床结果，以帮助证明影像引导 OR 的价值。
