[Current developments in healthcare information technology : Impact on structured reporting]. / Gegenwärtige Entwicklungen in der Healthcare-Informationstechnologie : Auswirkungen auf die strukturierte Befundung.

Structured reporting has become established in many radiological applications over the last 20 years. However, its significance is often still seen as being limited to a narrow section of clinical workflows-image reporting and the creation of radiological reports. By placing every clinical and radiological finding in a semantic context from which its clinical meaning can be reproduced at any time, even by digital assistance systems, structured handling of medical data is essential for the interoperability of clinical systems along the entire diagnostic and therapeutic pathway.

Diagnostic value of MRI-based 3D texture analysis for tissue characterisation and discrimination of low-grade chondrosarcoma from enchondroma: a pilot study.

OBJECTIVES: To explore the diagnostic value of MRI-based 3D texture analysis to identify texture features that can be used for discrimination of low-grade chondrosarcoma from enchondroma. METHODS: Eleven patients with low-grade chondrosarcoma and 11 patients with enchondroma were retrospectively evaluated. Texture analysis was performed using mint Lesion: Kurtosis, entropy, skewness, mean of positive pixels (MPP) and uniformity of positive pixel distribution (UPP) were obtained in four MRI sequences and correlated with histopathology. The Mann-Whitney U-test and receiver operating characteristic (ROC) analysis were performed to identify most discriminative texture features. Sensitivity, specificity, accuracy and optimal cut-off values were calculated. RESULTS: Significant differences were found in four of 20 texture parameters with regard to the different MRI sequences (p<0.01). The area under the ROC curve values to discriminate chondrosarcoma from enchondroma were 0.876 and 0.826 for kurtosis and skewness in contrast-enhanced T1 (ceT1w), respectively; in non-contrast T1, values were 0.851 and 0.822 for entropy and UPP, respectively. The highest discriminatory power had kurtosis in ceT1w with a cut-off ≥3.15 to identify low-grade chondrosarcoma (82 % sensitivity, 91 % specificity, accuracy 86 %). CONCLUSION: MRI-based 3D texture analysis might be able to discriminate low-grade chondrosarcoma from enchondroma by a variety of texture parameters. KEY POINTS: • MRI texture analysis may assist in differentiating low-grade chondrosarcoma from enchondroma. • Kurtosis in the contrast-enhanced T1w has the highest power of discrimination. • Tools provide insight into tumour characterisation as a non-invasive imaging biomarker.

Liver tissue sparing resection using a novel planning tool.

PURPOSE: Accurate preoperative prediction of liver function, volume, and vessel anatomy is essential in preventing postoperative liver failure, optimizing safety, and ensuring optimal outcome in patients undergoing hepatic surgery. We propose that preoperative resection planning provides useful anatomical and volumetric data, allowing for sparing of liver tissue in surgical resections. The purpose of the present study was to evaluate the use of a novel resection planning tool. METHODS: Thirteen patients undergoing hemihepatectomy were included. Preoperative resection planning was performed using the commercially available software Mint Liver. During resection planning, virtual resections were calculated based on Couinaud classification, Cantlie's line (standard), and individually by the operating surgeon (individual). Intraoperatively, volume and weight of the resected specimen were measured. A 14-day follow-up was conducted, and laboratory parameters were collected. Statistical analysis was performed, comparing virtual resection volumes (i.e., standard vs. individual) and secondarily virtual vs. actual resection volume. RESULTS: We found a significant difference (p = 0.001) in the comparison of standard vs. individual in all 13 cases, with an average 92.8 mL smaller resected volume, sparing 11.3% of liver parenchyma with virtual resection. No patients suffered from acute liver failure. Perioperative mortality was 0%. CONCLUSION: Mint Liver is capable of acquiring exact anatomical and volumetric knowledge prior to hepatic resections. Liver parenchyma can be spared by preoperative assessment of the resection plan. We propose that this tool could be an important addition to preoperative patient evaluation, especially in complex liver surgery and living donor liver transplantation where precise volumetry is the decisive factor.

A reporting and analysis framework for structured evaluation of COVID-19 clinical and imaging data.

The COVID-19 pandemic has worldwide individual and socioeconomic consequences. Chest computed tomography has been found to support diagnostics and disease monitoring. A standardized approach to generate, collect, analyze, and share clinical and imaging information in the highest quality possible is urgently needed. We developed systematic, computer-assisted and context-guided electronic data capture on the FDA-approved mint LesionTM software platform to enable cloud-based data collection and real-time analysis. The acquisition and annotation include radiological findings and radiomics performed directly on primary imaging data together with information from the patient history and clinical data. As proof of concept, anonymized data of 283 patients with either suspected or confirmed SARS-CoV-2 infection from eight European medical centers were aggregated in data analysis dashboards. Aggregated data were compared to key findings of landmark research literature. This concept has been chosen for use in the national COVID-19 response of the radiological departments of all university hospitals in Germany.

Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). / Strukturierte Befundung von soliden und zystischen Pankreasläsionen im CT und MRT: Konsensus-basierte Befundvorlagen der Deutschen Röntgengesellschaft (DRG).

BACKGROUND: Radiological reports of pancreatic lesions are currently widely formulated as free texts. However, for optimal characterization, staging and operation planning, a wide range of information is required but is sometimes not captured comprehensively. Structured reporting offers the potential for improvement in terms of completeness, reproducibility and clarity of interdisciplinary communication. METHOD: Interdisciplinary consensus finding of structured report templates for solid and cystic pancreatic tumors in computed tomography (CT) and magnetic resonance imaging (MRI) with representatives of the German Society of Radiology (DRG), German Society for General and Visceral Surgery (DGAV), working group Oncological Imaging (ABO) of the German Cancer Society (DKG) and other radiologists, oncologists and surgeons. RESULTS: Among experts in the field of pancreatic imaging, oncology and pancreatic surgery, as well as in a public online survey, structured report templates were developed by consensus. These templates are available on the DRG homepage under www.befundung.drg.de and will be regularly revised to the current state of scientific knowledge by the participating specialist societies and responsible working groups. CONCLUSION: This article presents structured report templates for solid and cystic pancreatic tumors to improve clinical staging (cTNM, ycTNM) in everyday radiology. KEY POINTS: · Structured report templates offer the potential of optimized radiological reporting with regard to completeness, reproducibility and differential diagnosis.. · This article presents consensus-based, structured reports for solid and cystic pancreatic lesions in CT and MRI.. · These structured reports are available open source on the homepage of the German Society of Radiology (DRG) under www.befundung.drg.de.. CITATION FORMAT: · Persigehl T, Baumhauer M, Baeßler B et al. Structured Reporting of Solid and Cystic Pancreatic Lesions in CT and MRI: Consensus-Based Structured Report Templates of the German Society of Radiology (DRG). Fortschr Röntgenstr 2020; 192: 641 - 655.

Robotic and imaging in urological surgery.

PURPOSE OF REVIEW: New imaging modalities and tissue navigation systems, which are adoptable to minimally invasive robotic urological surgical systems and prone to make the procedures more precise and easy, are reviewed. RECENT FINDINGS: Image-guided surgery as the general name of combining information of imaging modalities with real-time surgery has already found a place in open and minimally invasive procedures. Soft tissue navigation is a complex type of computer-assisted surgery for soft tissue interventions. Robotic surgery has advantages of superior degrees of freedom and three-dimensional stereotactic user interface. A combination of surgical robotics with image-assisted surgery and soft tissue navigation may offer advantages of more precise anatomical target localization and dissection with minimal damage to the tissue. Solving the problem of organ shift and as a result, unpredictable changing of intraoperative anatomy soft tissue navigation has the potential to increase the precision of minimally invasive robotic surgery. SUMMARY: Apart from less invasiveness, the concomitant use of minimal invasive robotic systems with soft tissue navigation enhances surgical precision. However, at present, abdominal navigation systems are in experimental use and not perfect enough for daily surgical routine.

Navigation in endoscopic soft tissue surgery: perspectives and limitations.

Despite rapid developments in the research areas of medical imaging, medical image processing, and robotics, the use of computer assistance in surgical routine is still limited to diagnostics, surgical planning, and interventions on mostly rigid structures. In order to establish a computer-aided workflow from diagnosis to surgical treatment and follow-up, several proposals for computer-assisted soft tissue interventions have been made in recent years. By means of different pre- and intraoperative information sources, such as surgical planning, intraoperative imaging, and tracking devices, surgical navigation systems aim to support surgeons in localizing anatomical targets, observing critical structures, and sparing healthy tissue. Current research in particular addresses the problem of organ shift and tissue deformation, and obstacles in communication between navigation system and surgeon. In this paper, we review computer-assisted navigation systems for soft tissue surgery. We concentrate on approaches that can be applied in endoscopic thoracic and abdominal surgery, because endoscopic surgery has special needs for image guidance due to limitations in perception. Furthermore, this paper informs the reader about new trends and technologies in the area of computer-assisted surgery. Finally, a balancing of the key challenges and possible benefits of endoscopic navigation refines the perspectives of this increasingly important discipline of computer-aided medical procedures.

Mobile augmented reality for computer-assisted percutaneous nephrolithotomy.

PURPOSE: Percutaneous nephrolithotomy (PCNL) plays an integral role in treatment of renal stones. Creating percutaneous renal access is the most important and challenging step in the procedure. To facilitate this step, we evaluated our novel mobile augmented reality (AR) system for its feasibility of use for PCNL. METHODS: A tablet computer, such as an iPad[Formula: see text], is positioned above the patient with its camera pointing toward the field of intervention. The images of the tablet camera are registered with the CT image by means of fiducial markers. Structures of interest can be superimposed semi-transparently on the video images. We present a systematic evaluation by means of a phantom study. An urological trainee and two experts conducted 53 punctures on kidney phantoms. RESULTS: The trainee performed best with the proposed AR system in terms of puncturing time (mean: 99 s), whereas the experts performed best with fluoroscopy (mean: 59 s). iPad assistance lowered radiation exposure by a factor of 3 for the inexperienced physician and by a factor of 1.8 for the experts in comparison with fluoroscopy usage. We achieve a mean visualization accuracy of 2.5 mm. CONCLUSIONS: The proposed tablet computer-based AR system has proven helpful in assisting percutaneous interventions such as PCNL and shows benefits compared to other state-of-the-art assistance systems. A drawback of the system in its current state is the lack of depth information. Despite that, the simple integration into the clinical workflow highlights the potential impact of this approach to such interventions.

The Medical Imaging Interaction Toolkit: challenges and advances : 10 years of open-source development.

PURPOSE: The Medical Imaging Interaction Toolkit (MITK) has been available as open-source software for almost 10 years now. In this period the requirements of software systems in the medical image processing domain have become increasingly complex. The aim of this paper is to show how MITK evolved into a software system that is able to cover all steps of a clinical workflow including data retrieval, image analysis, diagnosis, treatment planning, intervention support, and treatment control. METHODS: MITK provides modularization and extensibility on different levels. In addition to the original toolkit, a module system, micro services for small, system-wide features, a service-oriented architecture based on the Open Services Gateway initiative (OSGi) standard, and an extensible and configurable application framework allow MITK to be used, extended and deployed as needed. A refined software process was implemented to deliver high-quality software, ease the fulfillment of regulatory requirements, and enable teamwork in mixed-competence teams. RESULTS: MITK has been applied by a worldwide community and integrated into a variety of solutions, either at the toolkit level or as an application framework with custom extensions. The MITK Workbench has been released as a highly extensible and customizable end-user application. Optional support for tool tracking, image-guided therapy, diffusion imaging as well as various external packages (e.g. CTK, DCMTK, OpenCV, SOFA, Python) is available. MITK has also been used in several FDA/CE-certified applications, which demonstrates the high-quality software and rigorous development process. CONCLUSIONS: MITK provides a versatile platform with a high degree of modularization and interoperability and is well suited to meet the challenging tasks of today's and tomorrow's clinically motivated research.

Augmented reality visualization during laparoscopic radical prostatectomy.

PURPOSE: We present an augmented reality (AR) navigation system that conveys virtual organ models generated from transrectal ultrasonography (TRUS) onto a real laparoscopic video during radical prostatectomy. By providing this additional information about the actual anatomy, we can support surgeons in their working decisions. This work reports the system's first in-vivo application. MATERIALS AND METHODS: The system uses custom-developed needles with colored heads that are inserted into the prostate as soon as the organ surface is uncovered. These navigation aids are once segmented in three-dimensional (3D) TRUS data that is acquired right after the placement of the needles and then continuously tracked in the laparoscopic video images by the surgical navigation system. The navigation system traces the navigation aids in real time and computes a registration between TRUS image and laparoscopic video based on the two-dimensional-three dimensional (2D-3D) point correspondences. With this registration, the system correctly superimposes TRUS-based 3D information on an additional AR monitor placed next to the normal laparoscopic screen. Surgical navigation guidance took place until the prostate was removed from the rectal wall. Finally, the navigation aids were removed together with the specimen inside the specimen bag. RESULTS: The initial human in-vivo application of the surgical navigation system was successful. No complications occurred, the prostate was removed together with the navigation aids, and the system supported the surgeons as intended with an AR visualization in real time. In case of tissue deformations, changes in the spatial configuration of the navigation aids are detected, which preserves the system from erroneous navigation visualization. CONCLUSIONS: Feasibility of the navigation system was shown in the first in-vivo application. TRUS information could be superimposed via AR in real time. To show the benefit for the patient, results obtained from a larger number of trials are needed.

In-vitro evaluation of a soft-tissue navigation system for laparoscopic prostatectomy.

PURPOSE: We introduce a custom-designed phantom model for the in-vitro evaluation of an augmented reality-based soft-tissue navigation system for ultrasound-guided prostate interventions. MATERIALS AND METHODS: Transrectal ultrasound segmentation of the prostate, navigation aid placement, initial registration, endoscope tracking, and enhanced visualization steps in the navigation procedure were performed to accommodate the actual prostatic motion. In-vitro laparoscopic manipulations simulating surgical procedures were performed by a physician using human prostate specimens. The target visualization error, defining the accuracy of the tracking, is determined by means of a leave-out test strategy by alternately using four navigation aids for endoscope registration and the remaining two navigation aids for accuracy verification. RESULTS: The introduction of the navigation aids lasted approximately 3 minutes. The navigation aids and especially their barbs were visible because of their ultrasound reflecting nature. For each organ, 1000 endoscope registrations were calculated, in which two randomly chosen navigation aids served the purpose of verifying the pose. We were able to demonstrate that the superimposed image could follow automatically the videoendoscopic real-time view. The mean target visualization errors for the respective trials were determined as 0.81 (±0.12) mm, 0.62 (±0.14) mm, and 0.98 (±0.23) mm. CONCLUSIONS: The ultrasound-based inside-out navigation system for laparoscopic prostatectomy overcomes the problem of tissue shift and deformation in an in-vitro model. In case of organ movement, the augmented picture with the detected navigation aids could follow the videoendoscopic image using the navigation aids as landmarks.

The role of imaging and navigation for natural orifice translumenal endoscopic surgery.

BACKGROUND AND PURPOSE: One of the next frontiers of minimally invasive surgery is natural orifice translumenal endoscopic surgery (NOTES). This article focuses on the perspectives and limitations of imaging and navigation in NOTES soft-tissue surgery. MATERIALS AND METHODS: Based on our in-vitro and in-vivo studies, with the applicability of different systems for image-guided soft-tissue endoscopic surgery, early experience with NOTES, and long-term experience with advanced endoluminal, laparoscopic robot-assisted endoscopic surgery, we performed a review of the literature. The aim was a critical analysis of the current role of imaging during NOTES. RESULTS: There are several steps/problems with NOTES that might be significantly alleviated by use of imaging and soft-tissue navigation. One has to distinguish between preoperative planning and intraoperative imaging or navigation. NOTES represents a hybrid technique of laparoscopy and endoscopy with similar limitations in perception and two-dimensional imaging; however, the use of flexible instruments increases the complexity with respect to the spatial orientation. This applies not only for the surgeon, but also for tracking devices for surgical navigation systems. Unlike optical navigation systems, electromagnetic and endoscopic (inside-out) tracking devices might be best suited to NOTES. CONCLUSION: The safe realization and standardization of NOTES represents a real challenge that necessitates close and effective interdisciplinary collaboration of surgeon, technicians, informatics, and endoscopic and applied industries. Image-guided soft-tissue navigation may be very helpful to minimize the hazards of the technically challenging procedure.