Rohan Gujjuri speaks to Alvaro Garcia-Granero about 3D imaging and printing for planning operations and what we can expect from his talk at Virtually Vilnius.

Alvaro Garcia-Granero is a consultant surgeon at the Colorectal Surgery Unit in Hospital Universitario Son Espases in Palma de Mallorca. He is also a Professor of Human Embryology and Anatomy at the University of Valencia and is Secretary of Coloproctology Section of the Spanish Association of Surgeons.

Microscopically tumour-free resection margins are the most important prognostic factor for advanced rectal cancer. Magnetic resonance imaging (MRI) is the gold standard to assess it preoperatively, however it has been reported a positive predictive value of 64% for a circumferential resection margin involved.

Rohan Gujjuri: What do you want to add to the subject?

Alvaro Garcia-Granero: The application of mathematical 3D-method (3D-IPR) to preoperative MRI can generate tridimensional images of the pelvis, as well as define the structure invaded by the tumour, suggesting the desirable surgical plane to achieve R0 resections.

The aim of our pilot report is to investigate the diagnostic reliability of a 3D-based model of image processing and reconstruction (3D-IPR) based on pelvic MRI, using it as an endpoint for the detection and depth of tumour invasion.

RG: What are the key points to know?

AGG: 3D-IPR was generated by pelvic MRI pre-processing using 'bias field correction' algorithms and anisotropic diffusion filtering of images, segmentation of medical images of the included sequences using active contours algorithms, and dynamically modified, atlas-based image acquisition. Lastly, 3D surface was reconstructed by means of modified marching cubes algorithms.

RG: Why is your talk useful to attend?

AGG: In a time when pelvic exenterations and extra-anatomical resections are being offered to an increasing number of patients - due to perioperative and intraoperative technical and technological advances - we believe that our report could be of great interest.

We show the first study based on a mathematical algorithm to deal with the area of invasion of peri-rectal structures as a specific entity with its proper 'identity'. The presence/absence of infiltration/no-infiltration could be oriented by mathematical algorithms and 3D-reconstruction.

RG: What are the future developments in the field?

AGG: Artificial intelligence is a rapidly evolving field and it is contributing much to the understanding and management of several medical conditions. A rapid pace of progress is being observed in diagnostic imaging, as well, with the first applications of 3D imaging and stereotactic surgery being described. In our report, we tried to assess the diagnostic yield offered by artificial intelligence added to conventional magnetic resonance scan in terms of preoperative estimation of tumour invasion into surrounding structures.

Alvaro’s session on ‘3D imaging and printing for planning operations’ will take place at ESCP Virtually Vilnius 2020 between 14:55 - 15:25 on Tuesday 22 September.

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