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Three-dimensional tomosynthesis and cone-beam computed tomography: An experimental study for fast, low-dose intraoperative imaging technology for guidance of sinus and skull base surgery

Authors

  • Gideon Bachar MD,

    Corresponding author
    1. From the Department of Otolaryngology–Head and Neck Surgery and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    • Princess Margaret Hospital, 610 University Avenue 3-954, Toronto, Ontario M5G 2M9, Canada
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    • Drs. Bachar and Barker contributed equally to this study.

  • Emma Barker MD,

    1. From the Department of Otolaryngology–Head and Neck Surgery and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • Sajendra Nithiananthan BSc,

    1. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
    2. Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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  • Harley Chan PhD,

    1. From the Department of Otolaryngology–Head and Neck Surgery and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
    2. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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  • Michael J. Daly MSc,

    1. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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  • Jonathan C. Irish MD,

    1. From the Department of Otolaryngology–Head and Neck Surgery and Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • Jeffrey H. Siewerdsen PhD

    1. Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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Abstract

Objectives:

To describe three-dimension (3-D) tomosynthesis and cone beam computed tomography (CBCT) as an intraoperative imaging system to guide both sinus and skull-base surgery in a cadaveric model.

Methods:

Five cadaveric heads underwent baseline CBCT imaging. Surgical targets were resected from each head (uncinectomy, ethmoidectomy, medial maxillectomy, pituitary gland resection, and clivus ablation). Intraoperative imaging was provided so that for a given task, the acquisition arc (θtot = 20°, 45°, 60°, 90°, 178°) of the tomosynthesis scan was fixed. Different heads and tasks were allocated different acquisition angles. There was no limit to the number of scans that could be requested. Residual target was highlighted with 3-D visualization software.

Results:

The larger the image acquisition angle, the better the image. Only CBCT (θtot ∼178°) provided nearly isotropic 3-D spatial resolution and soft-tissue visibility in all three views. The volume of residual tissue remaining and the volume of adjacent-normal tissue that was resected were calculated as a function of tomosynthesis angle. For the easier surgical tasks (uncinectomy, ethmoidectomy) the residual tissue was not related to the tomosynthesis angle. However, for the difficult ablative tasks, the image quality became more important and tomosynthesis angle was related to the residual tissue.

Conclusions:

We describe an intraoperative imaging platform that can deliver near-real-time images of the target and related structures with low radiation dose. Tomosynthesis scanning angles higher than 60° provided quantifiable benefits to the surgeon and facilitated total target ablation while helping to spare surrounding structures. Laryngoscope, 119:434–441, 2009

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