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Eur J Cardiothorac Surg 2007;31:506-511. doi:10.1016/j.ejcts.2006.11.054
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

The feasibility of three-dimensional displays of the thorax for preoperative planning in the surgical treatment of lung cancer

^a The Canadian Surgical Technology and Advanced Robotics, London Health Sciences Centre, London, Ontario, Canada
^b Department of Electrical and Computer Engineering, The University of Calgary, Calgary, Alberta, Canada
^c Division of Thoracic Surgery, The University of Western Ontario, London, Ontario, Canada

Received 11 September 2006; received in revised form 21 November 2006; accepted 24 November 2006.

^_* Corresponding author. Address: London Health Sciences Centre, Suite E2-124, 800 Commissioners Road East, London, Ontario, Canada N6A 5W9. Tel.: +1 519 667 6835; fax: +1 519 667 6517. (Email: richard.malthaner{at}lhsc.on.ca).

Objective: Three-dimensional (3D) displays of anatomic structures have become feasible for preoperative planning in some surgical procedures. There have been no reports, however, on the use of 3D displays for surgical treatment of lung cancer. We hypothesized that 3D displays of the thorax are useful for preoperative planning for lung cancer. Methods: Based on virtual reality technologies, we rendered 3D displays of the thorax from two-dimensional (2D) computed tomographic (CT) images of six anonymous patients, some of whom underwent surgical removal of lung cancer. For determining the resectability of lung cancer, we tested 17 participants with varying degrees of surgical skills to view 3D displays and read 2D CT images of these thoracic cavities in a randomized order. We measured their performance in terms of the accuracy of predicted resectability, the confidence of their prediction, planning time used, and workload experienced. Results: The results demonstrated that viewing 3D displays of thoracic cavities has significant advantages over reading 2D CT images in determining the resectability of lung cancer: increasing the accuracy of predicted resectability by about 20%, enhancing the confidence of the prediction by about 20%, decreasing planning time by about 30%, and reducing workload by about 50%. All participants preferred viewing 3D displays to reading 2D CT images for preoperative planning. Junior residents found 3D displays of thoraces more useful than senior residents. Conclusions: It is feasible to use 3D displays of the thorax for preoperative planning in treating lung cancer. Using 3D displays in surgical treatment of lung cancer has potential benefits, once the technique is perfected.

Key Words: Preoperative planning • 3D displays • Virtual reality • 2D CT • Lung surgery

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