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real-time. As the endoscope changes position, the crosshair of the tumor site would continually track tumor location and depth. Depending on the method of removal, tip tracking of the resection tools as they are advanced to the target can be in-cluded to ensure accuracy. Since treatment margins are large, the tracking accuracy required is approx- imately 3-5 mm. Follow-up CT can be used to ensure complete resection. Imaging Facilitates Best Possible Outcomes The GTx-OR initiative is led by the Techna Institute, a Research and Development Center at UHN that brings surgeons, physicists, scientists, engineers and imaging specialists together to explore and refine new operating techniques – both open and minimally invasive – supported by the latest imaging technologies. Surgical innovations devised by Techna will only be trialed and further developed in the GTx-OR after extensive pre-clinical testing. The goal is to use the advanced Siemens equipment to enable physicians to quickly and accurately image patients while they are on the operating table, thereby helping surgeons provide the best possible outcomes through the use of image-guided procedures. Contact nadine.brown@siemens.com by the location and size of the nodule. As a result, there is an increasing demand for VATS for tissue diagnosis as well as treatment of such nodules. VATS is in fact becoming the standard of care for resection of lung neoplasm. The VATS procedure is performed on a deflated lung in the region of the lesion. Nodules located near the surface of the lung can be detected during VATS without palpation. However, most nodules are too small and located deeper than the surface and thus difficult to find using VATS alone. As a result, some patients require a thoracotomy for palpation. Once nodules are identified, endostaplers are used to perform wedge resection for diagnostic purposes, and pathology is performed to confirm negative margins on resected specimens. Because of the significant disconnect between the localization of the tumor in the diagnostic CT and the VATS procedure, patients may end up undergoing a large thoracotomy for complete resection. This results in significant reduction in patient quality of life. One proposal for how to address this problem using the GTx-OR configuration is that: • Flash CT immediately prior to the procedure with the patient in the surgical procedure position to identify lung nodules; • syngo DynaCT using the Artis zeego to register the patient and tumor position with that of the thorascope; • Tracked and integrated video from the thorascope be used to guide the surgical procedure. A CT of the lung prior to the procedure followed by registration of this image to a syngo DynaCT using the Artis zeego during the procedure would give proper localization of the lung nodule in the surgical field frame of reference. Real-time tracking of the tumor location on the endoscopic image, using updated 3D images with the Artis zeego, would ensure more accurate targeting during the resection. With greater confidence in localizing the target, surgeons would be able to reduce the volume of excised tissue. With registration of the thorascopic tool to the CT frame of reference, the tumor target can be identified on the endoscopic image in Jay Parkes is a freelance Information Technology writer focused on the use of informatics and technology in healthcare. Update on Thoracic Surgery at Völklingen, Germany In our previous edition 16 in December 2013 we published an article “Very Promissing Addition” (page 68) with Helmut Isringhaus, MD, Head of the Department of Cardiothoracic Surgery at the SHG Hospital in Völklingen, Germany. Dr. Isringhaus and his team, Klaus Urbschat, MD, and Alexander Gremekeli, MD are further developing the workflow regarding small pulmonary lung nodules. Using a large volume syngo DynaCT they are now able not only to cover the entire lung but also the skin around it. This is crucial for the exact pathway of the needle for the thread placement. It is necessary for the surgeon to find the entrance point through the skin into the lung for the precise placement with the support of syngo iGuide. After the needle thread is placed close to the nodule it is resected in a minimally invasive approach. What is appreciated most is that this procedure takes place in one room at one time. Dr. Isringhaus said that “being able to treat the patient in a single procedure is much safer for the patient because the risks like haematothorax and pneumothorax through the placement of the thread can be controlled in a surgical setting. The patient only needs one procedure and also with the minimally invasive approach he is able to recover quicker.” He also believes that the future of thoracic surgery is minimally invasive surgery; surgical instruments and imaging technology will develop further and safer and better treatment will be possible. “In parts of the world CT screening for high risk patients is already in use. This will lead to many more patients with small pulmonary nodules of unknown dignity. Especially when resecting nodules within the parenchyma, imaging plays a crucial role and image guiding surgery will become even more important,” he stated. Further Information http://technainstitute.com/ resources-places/gtxor Angiography and Computer Tomography Surgery AXIOM Innovations | December 2013 | www.siemens.com/angiography  57


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