Visualization support for the planning of hepatic needle placement.

PURPOSE: Percutaneous image-guided interventions, such as radiofrequency ablation or biopsy, are using needle-shaped instruments which have to be inserted into a target area without penetrating any vital structure. The established planning workflow is based on viewing 2D slices of a pre-interventional CT or MR scan. However, access paths not parallel to the axial plane are often necessary. For such complicated cases, the planning process is challenging and time consuming if solely based on 2D slices. To overcome these limitations while keeping the well-established workflow, we propose a visualization method that highlights less suited paths directly in the 2D visualizations with which the radiologist is familiar. METHODS: Based on a user defined target point and segmentation masks of relevant risk structures, a risk structure map is computed using GPU accelerated volume rendering and projected onto the 2D slices. This visualization supports the user in defining safe linear access paths by selecting a second point directly in the 2D image slices. RESULTS: In an evaluation for 20 liver radiofrequency ablation cases, 3 experienced radiologists stated for 55% of the cases that the visualization supported the access path choice. The visualization support was rated with an average mark of 2.2. For 2 of the 3 radiologists, a significant reduction of the planning duration by 54 and 50% was observed. CONCLUSIONS: The proposed visualization approach can both accelerate the access path planning for radiofrequency ablation in the liver and facilitate the differentiation between safer and less safe paths.

State of the art in computer-assisted planning, intervention, and assessment of liver-tumor ablation.

Percutaneous, image-guided thermal tumor ablation procedures are used increasingly for minimally invasive, local treatment of tumors in the liver. The planning of these procedures; the support of targeting, monitoring, and controlling during the intervention itself; and the assessment of the treatment response can all benefit significantly from computer assistance. The outcome can be optimized by supporting the physician in the process of determining an intervention strategy that enables complete destruction of the targeted tumor while reducing the danger of complications. During the intervention, computer-assisted methods can be used to guide the physician in the implementation of the intended strategy by providing planning information. Assessment of the intervention result is carried out by comparison of the achieved coagulation with the target tumor volume. Supporting this comparison facilitates the early detection of potential recurrences. This report provides an overview of state-of-the-art computer-assisted methods for the support of thermal tumor ablations in the liver. Proper approaches for image segmentation, access-path determination, simulation, visualization, interventional guidance, and post-interventional assessment, as well as integrated work flow-oriented solutions, are reviewed with respect to technical aspects and applicability in the clinical setting.