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Impact of deformation on a supine-positioned image-guided breast surgery approach

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Abstract

Purpose

To reduce reoperation rates for image-guided breast-conserving surgery, the enhanced sensitivity of magnetic resonance (MR) supine imaging may be leveraged. However, accurate tissue correspondence between images and their physical counterpart in the surgical presentation is challenging due to breast deformations (e.g., from patient/arm position changes, and operating room table rotation differences). In this study, standard rigid registration methods are employed and tissue deformation is characterized.

Methods

On n = 10 healthy breasts, surface displacements were measured by comparing intraoperative fiducial locations as the arm was moved from conventional MR scanning positions (arm-down and arm-up) to the laterally extended surgical configuration. Supine MR images in the arm-down and arm-up positions were registered to mock intraoperative presentations.

Results

Breast displacements from a supine MR imaging configuration to a mock surgical presentation were 28.9 ± 9.2 mm with shifts occurring primarily in the inferior/superior direction. With respect to supine MR to surgical alignment, the average fiducial, target, and maximum target registration errors were 9.0 ± 1.7 mm, 9.3 ± 1.7 mm, and 20.0 ± 7.6 mm, respectively. Even when maintaining similar arm positions in the MR image and mock surgery, the respective averages were 6.0 ± 1.0 mm, 6.5 ± 1.1 mm, and 12.5 ± 2.8 mm.

Conclusion

From supine MR positioning to surgical presentation, the breast undergoes large displacements (9.9–70.1 mm). The data also suggest that significant nonrigid deformations (9.3 ± 1.7 mm with 20.0 mm average maximum) exist that need to be considered in image guidance and modeling applications.

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Funding

This work was supported by NIH-NIBIB awards T32EB021937, R21EB022380, R01EB027498, and Vanderbilt Grant 1S10OD021771-01.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Vanderbilt University, 1225 Stevenson Center Ln, Nashville, 37235, USA

    Winona L. Richey, Jon S. Heiselman, Ma Luo & Michael I. Miga

  2. Vanderbilt Institute for Surgery and Engineering, 1161 21st Ave. S, Nashville, 37204, USA

    Winona L. Richey, Jon S. Heiselman, Ma Luo, Ingrid M. Meszoely & Michael I. Miga

  3. Division of Surgical Oncology, Vanderbilt University Medical Center, 719 Thompson Ln Suite 22100, Nashville, 37232, USA

    Ingrid M. Meszoely

  4. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave. S, Nashville, 37232, USA

    Michael I. Miga

  5. Department of Neurological Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA

    Michael I. Miga

  6. Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA

    Michael I. Miga

  7. Vanderbilt University, 1225 Stevenson Center Ln, Stevenson Center 5824, Nashville, TN, 37240, USA

    Winona L. Richey

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  1. Winona L. Richey
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Correspondence to Winona L. Richey.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Richey, W.L., Heiselman, J.S., Luo, M. et al. Impact of deformation on a supine-positioned image-guided breast surgery approach. Int J CARS 16, 2055–2066 (2021). https://doi.org/10.1007/s11548-021-02452-8

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