3d scanner set up and specimen handling for scanning and virtual mapping of cancer resections

Fortschrittliche CAD-Bildgebung für die chirurgische Randanalyse in der Krebsbehandlung

The goal of oncologic resection is the complete removal of cancer with surgical margins microscopically clear of tumor cells. In head and neck cancer, the surgical margin status is the most important pathologic risk factor1. A positive surgical margin increases the risk of 5-year local recurrence and all-cause mortality by &#62;90%2. Despite advances in medical technology and surgical techniques in recent years, positive margin rates in head and neck cancer remain high3. For locally advanced oral cavity cancers, the positive margin rate within the United States is 18.1%4.
For head and neck surgeons to ensure complete oncologic resection while minimizing disruption of surrounding structures, intraoperative sampling of margins via frozen section analysis (FSA) is performed. FSA provides a rapid intraoperative pathology consultation that is widely used and is the standard of care5,6,7,8,9. Fresh tissue is frozen, thinly sliced, placed on a glass slide, and stained for immediate interpretation while the patient is still under anesthesia.
Head and neck oncologic specimens present several distinct challenges in accurately assessing margin status, including the anatomic complexity of head and neck cancer specimens, the minimal reserve in the head and neck region for wide excision given the proximity to vital structures such as the eyes, face, and important nerves and vasculature, and the multiple tissue types often present in the resected specimen (i.e., mucosa, cartilage, muscle, bone)10,11. Thus, a specimen-based approach to margin analysis requires an enhanced level of communication between surgeon and pathologist12. A face-to-face conversation is often warranted to ensure correct specimen orientation and discussion of concerning margins. However, this is not always safe or feasible as it requires either the surgeon to leave the operating room (OR) while the patient remains under general anesthesia or the pathologist to leave the gross pathology lab, interrupting their workflow. In addition, there may be a significant travel time between the OR and the pathology lab, or in some cases, the pathology lab may be off-site altogether.
Following FSA, the oncologic specimen is fixed in formalin and formally processed through inking, sectioning, and margin sampling. Slides are created and microscopically interpreted by the pathologist to create a final pathology report. For complex head and neck cancer resection, this can often take 1-2 weeks. Unfortunately, processing of the specimen commonly results in the destruction of the resected cancer specimen. This may create further confusion as the final pathology report, multidisciplinary tumor board discussions, adjuvant radiation therapy planning, and re-resection in the setting of positive margins, must all proceed without a visual record of the oncologic specimen and its pathologic processing.
To address this clinical unmet need, we have developed a 3D scanning and specimen mapping protocol to enhance communication between surgeons, pathologists, and other members of the multidisciplinary cancer care team.

Autor im Rampenlicht: 3D-Scanning und Augmented Reality für eine verbesserte Kommunikation in der Krebschirurgie

Verbesserte Kommunikation von Tumorrändern durch 3D-Scannen und -Mapping

The scope of our research is to use 3D scanning and augmented reality technology to improve communication of cancer surgery results among the multidisciplinary cancer care team. More specifically, we're hoping to allow for a surgeon to re-resect cancer more precisely and allow for more precise radiation therapy. In the hospital environment, space is often limited, and finding additional room for extra personnel and equipment can be difficult.The learning curve on this protocol can also be challenging, especially for those without prior experience in 3D scanning and computer-aided design. We've created a 3D scanning and virtual mapping protocol for cancer specimens, providing a permanent visual record to go alongside written pathology reports. This is a powerful communication tool for the entire cancer care team and is now being investigated in multidisciplinary tumor board discussions, as well as adjuvant radiation therapy treatment planning.When a surgical specimen is processed for pathologic analysis, it is often destroyed, without any visual documentation. This results in lengthy written pathology reports and can often lead to challenging clinical scenarios in cases of a close or positive margin. Our research protocol creates an interactive, permanent visual record of the resected cancer specimen.Our protocol offers a novel visual representation of a surgically resected oncologic specimen and a map of how it was processed pathologically. This data previously did not exist and now allows providers to look back at a specimen for reference, multidisciplinary care discussions, and future treatment planning.

3D-Scanner-Einrichtung und Probenhandhabung zum Scannen und virtuellen Mapping von Krebsresektionen

Stellen Sie zunächst das dreibeinige Kamerastativ auf der flachen Workstation auf. Setzen Sie die 3D-Scankamera vorsichtig in das Stativ ein und richten Sie die Kamera in einem Winkel von 60 Grad nach unten zur Workstation aus. Schließen Sie das zweiteilige Netzkabel an eine externe Stromquelle und die Rückseite der Kamera an.Stellen Sie den Scanner-Drehteller einen Fuß vor die 3D-Kamera und das Stativ. Verbinden Sie den Plattenspieler mit dem Micro-USB-Kabel mit der Kamera. Schließen Sie dann die Kamera mit einem USB-Kabel an den Laptop an.Als nächstes entnehmen Sie die resezierte onkologische Probe vom Operationsteam. Spülen Sie die Probe mit Wasser ab, um Blut oder überschüssige Gerinnsel aus der Resektion zu entfernen, und polstern Sie sie vorsichtig trocken. Legen Sie die Probe auf eine ebene, saubere Oberfläche.Mit einer Smartphone-Kamera oder Digitalkamera erhalten Sie hochwertige 2D-Bilder der Vorderfläche der Probe. Drehen Sie die Probe genau um 180 Grad und machen Sie ein zweites Foto der hinteren Oberfläche.

Research

JoVE Journal

Medicine

3D Scanner Set Up and Specimen Handling for Scanning and Virtual Mapping of Cancer Resections

Enhanced Communication of Tumor Margins Using 3D Scanning and Mapping

After oncologic resection of malignant tumors, specimens are sent to pathology for processing to determine the surgical margin status. These results are ...

Forschung

Medizin

3D Scanning Following En Bloc Resection of Solid Tumor for Virtual Mapping of Cancer Resections

3D-Scannen nach En-Bloc-Resektion eines soliden Tumors zur virtuellen Kartierung von Krebsresektionen

Creating a Virtual 3D Specimen Map of Cancer Resections to Improve Multidisciplinary Care

Erstellen einer virtuellen 3D-Probenkarte von Krebsresektionen zur Verbesserung der multidisziplinären Versorgung