Creating Roadmaps for Surgeons
Using the Mac for Better Surgical Navigation

---

A woman in her forties lies anesthetized on an operating table. The surgical team prepares her torso for surgery, and switches on an overhead projector. A three-dimensional image of the patient’s internal organs appears on the surface of her abdomen and is aligned with her body. The image changes as Dr. Maki Sugimoto, using a wireless remote to control a Mac Pro workstation, navigates through the 3D volume to bring up the surgical target –early stage gastric cancer. Guided by the display, the team makes precise incisions to insert ports for laparoscopic surgery.

The same 3D images of the patient’s anatomy appear on a 23-inch Apple Cinema Display beside the surgical table. Sugimoto uses the remote to move and rotate images for a better view of the cancerous tissue. He inserts the laparoscope into a port and navigates to the surgery site, guided by the monitor of the scope and the reference images on the Apple Cinema Display.

In many operating rooms, this cancer would have been treated with aggressive open surgery. But in this case 3D visualization has enabled efficient, minimally invasive surgery and a better outcome for the patient.

Wanted: A Better Surgical Road Map

Sugimoto, an assistant professor at the 520-bed Teikyo University Chiba Medical Center near Tokyo, has been using Macs since his college days. Today he uses them to plan and conduct both minimally invasive and aggressive open surgery.

After Sugimoto completed his residency as an M.D. and secured a PhD in medical science at the Teikyo Graduate School of Medicine, he was appointed Assistant Professor at Teikyo University Chiba Medical Center. He was looking for ways to use imaging technology to improve surgical procedures.

“When you’re driving into new territory, you want a map, or better still a navigation system,” says Sugimoto. “We wanted to improve surgical accuracy and efficiency with image-guided navigation. We wanted all the surgeons on the surgical team to see the same visual data, the same images, so we can make informed decisions jointly.”

Sugimoto was browsing the Apple Web site in 2004 when he came across OsiriX, a Mac-based open-source software system for viewing DICOM-format radiological images. He downloaded OsiriX and began experimenting. He had found the navigation aid he needed.

Sugimoto began building his own surgical roadmaps. Today the Center’s radiology department takes CT scans of his patients, and sends him the DICOM files. He runs OsiriX on a Mac Pro or a MacBook Pro to segment them into volumetric 3D images that he uses to plan and perform surgery.

“OsiriX is easy,” says Sugimoto. “We learned it without formal training because its interface is similar to other Mac applications. Now we have a Japanese user interface for OsiriX, which makes it even easier for us. Students and residents can use it easily. And we can do the segmentation on our personal desktops or laptops anytime. This is important: even if we’re working on an emergency case at midnight, we can use OsiriX on a Mac to view the 3D volumes from multi-detector CT slices. We don’t need to wait for a radiologist to show us these images anymore.”

Minimally Invasive Surgery: Putting the Road Map on the Patient

For patients with early-stage gastric or colonic cancer, the surgical team typically opts for minimally invasive laparoscopic surgery. With the patient anesthetized, Sugimoto projects OsiriX-generated 3D images onto the body surface of the patient with an Epson EMP-1715 projector. Using a motion-sensing wireless remote, Sugimoto uses physiological markers (such as the navel) to register the image to the patient’s body. Then using a Color Look Up Table (CLUT) feature in OsiriX, he makes the skin of the image transparent. The display now shows the patient’s internal body parts and the area that he will need to operate on.