Step 7 - Resection Planning:

 

! Please note:

Until now it is not possible to fade in all existing structures of the list in color (2) in all available (1) datasets. In the venous dataset the liver capsule, the tumor and the veins can be superimposed. In the arterial dataset, however, only the arteries are superimposed. This is due to the refurbishment of the data. The extraction of the structures only takes place at one of the datasets and cannot be transferred to other datasets at the moment.

For the interaction with the original data, the following options are available and displayed under the large data view:

  • Scrolling through the layers: with the mouse wheel, fast slicing is carried out by pushing the middle mouse button and moving the mouse vertically
  • Windowing: changing of width through a pressed right mouse button with simultaneous horizontal movement of the mouse, changing of the center by pushing the right mouse button and moving the mouse vertically

 

  1. Select the venous dataset (1).
  2. In the structure list, activate the colored overlays of the portal vein (as support) (2) for the planning.
  3. It is possible to switch all colored overlays of the activated structures on and off simultaneously. Therefore, place or remove the checkmark (3).
  4. Now, start the intervention planning. A planning/a therapy proposal is saved in a strategy which is displayed (4) in the list.
  5. Create a strategy for your planning (5).
  6. Afterwards, add a resection surface to this strategy (6).

  1. Now, draw the transection lines into the (1) layer image data. Ideally, define these lines in every 4th or 5th layer and at critical points (e.g., intersections with vessels).
  2. It is possible to delete the line of a layer again by pushing the button "Undo Line" (2).
  3. The present resection can be cancelled with "Cancel Resection" (3). This command deletes all resection lines.
  4. Afterwards, let the transection plane be generated from the lines (4).

  1. Now, place a marker (click the left mouse button) in the part of the liver to be donated (1). Afterwards, both partial volumes are calculated automatically.

 

  1. Verify your planning by means of the liver vein and the liver artery. Therefore, fade in the colored overlays (2) and then choose the arterial dataset for the liver artery (1).
  2. If appropriate, you can directly manipulate the transection lines in the 2D layers with the mouse (click to the appropriate point at the line, leave the left mouse button pushed and move the mouse) to adapt them (3).
  3. When the lines are modified, the partial volumes of the liver should be recalculated (4).
  4. If you are satisfied with the transection line and the resulting volumes, go to the next step of the planning (5).
  5. If you have not placed the marker for the donor volume in a correct way, go one step back (6).

 

In this step, your planning result is presented on a 3D model of the liver and the vascular system of the patient. Verify your planning by means of this model.

  1. For a modification of your resection surface, first of all, choose the arrow tool (1) of the viewer. (Hint: The plane can only be distorted beyond the displayed structures. (Thus, it is recommended to hide the liver capsule at this step.)
  2. Now you can distort the plane in the 3D view. (2). The following options, which are displayed in the area under the viewer, are available for the interaction with the 3D model (Attention: for all interactions with the 3D model, the "hand" tool of the viewer must be chosen):
    • Rotation: press the left mouse button and move the mouse, or rotation in horizontal or vertical direction through the wheels "RotX" or "RotY" at the edge of the viewer
    • Shifting: pressed left mouse button and pressed control key and movement of the mouse
    • Zoom: press the left mouse button, the control key and the shift key simultaneously and move the mouse
    • Selection of an object: click on an object with the left mouse button
  3. For a better orientation you may additionally fade in the 2D viewer. The viewer is situated on the tab "Second Viewer" (3).
  4. After modification of the plane, the partial volumes of the liver should be recalculated (4).
  5. Save your work if you are satisfied with the planning (5).
  6. If you would like to modify the surface in 2D, go back to the previous step (6).

 

Now, go to the next step—the planning analysis.

 

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