Assessment of resectability of pancreatic cancer using novel immersive high-performance virtual reality rendering of abdominal computed tomography and magnetic resonance imaging

Julia Madlaina Kunz; Peter Maloca; Andreas Allemann; David Fasler; Savas Soysal; Silvio Däster; Marko Kraljević; Gulbahar Syeda; Benjamin Weixler; Christian Nebiker; Vincent Ochs; Raoul Droeser; Harriet Louise Walker; Martin Bolli; Beat Müller; Philippe Cattin; Sebastian Manuel Staubli

doi:10.1007/s11548-023-03048-0

Assessment of resectability of pancreatic cancer using novel immersive high-performance virtual reality rendering of abdominal computed tomography and magnetic resonance imaging

Int J Comput Assist Radiol Surg. 2024 Sep;19(9):1677-1687. doi: 10.1007/s11548-023-03048-0. Epub 2024 Jan 22.

Authors

Julia Madlaina Kunz¹, Peter Maloca^{2

3

4}, Andreas Allemann⁵, David Fasler⁶, Savas Soysal⁵, Silvio Däster⁵, Marko Kraljević⁵, Gulbahar Syeda⁷, Benjamin Weixler⁸, Christian Nebiker⁹, Vincent Ochs¹⁰, Raoul Droeser⁵, Harriet Louise Walker¹¹, Martin Bolli⁵, Beat Müller⁵, Philippe Cattin^#¹⁰, Sebastian Manuel Staubli^#^{12

13

14}

Affiliations

¹ Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
² Institute of Molecular and Clinical Ophthalmology Basel (IOB), Mittlere Strasse 91, 4031, Basel, Switzerland.
³ Department of Ophthalmology, University of Basel, 4031, Basel, Switzerland.
⁴ Moorfields Eye Hospital, NHS Foundation Trust, London, EC1V 2PD, UK.
⁵ Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland.
⁶ Department of Radiology St. Claraspital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
⁷ Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, NHS Foundation Trust, Pond Street, London, NW3 2Q, UK.
⁸ Department of General, Visceral and Vascular Sugery, Charité Campus Benjamin Franklin, Hindenburgdamm 20, 12203, Berlin, Germany.
⁹ Surgical Department, Cantonal Hospital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
¹⁰ Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167c, 4123, Allschwil, Switzerland.
¹¹ Department of Women's Health, University College London Hospitals, London, UK.
¹² Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland. s.staubli@nhs.net.
¹³ Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland. s.staubli@nhs.net.
¹⁴ Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, NHS Foundation Trust, Pond Street, London, NW3 2Q, UK. s.staubli@nhs.net.

^# Contributed equally.

Abstract

Purpose: Virtual reality (VR) allows for an immersive and interactive analysis of imaging data such as computed tomography (CT) and magnetic resonance imaging (MRI). The aim of this study is to assess the comprehensibility of VR anatomy and its value in assessing resectability of pancreatic ductal adenocarcinoma (PDAC).

Methods: This study assesses exposure to VR anatomy and evaluates the potential role of VR in assessing resectability of PDAC. Firstly, volumetric abdominal CT and MRI data were displayed in an immersive VR environment. Volunteering physicians were asked to identify anatomical landmarks in VR. In the second stage, experienced clinicians were asked to identify vascular involvement in a total of 12 CT and MRI scans displaying PDAC (2 resectable, 2 borderline resectable, and 2 locally advanced tumours per modality). Results were compared to 2D standard PACS viewing.

Results: In VR visualisation of CT and MRI, the abdominal anatomical landmarks were recognised by all participants except the pancreas (30/34) in VR CT and the splenic (31/34) and common hepatic artery (18/34) in VR MRI, respectively. In VR CT, resectable, borderline resectable, and locally advanced PDAC were correctly identified in 22/24, 20/24 and 19/24 scans, respectively. Whereas, in VR MRI, resectable, borderline resectable, and locally advanced PDAC were correctly identified in 19/24, 19/24 and 21/24 scans, respectively. Interobserver agreement as measured by Fleiss κ was 0.7 for CT and 0.4 for MRI, respectively (p < 0.001). Scans were significantly assessed more accurately in VR CT than standard 2D PACS CT, with a median of 5.5 (IQR 4.75-6) and a median of 3 (IQR 2-3) correctly assessed out of 6 scans (p < 0.001).

Conclusion: VR enhanced visualisation of abdominal CT and MRI scan data provides intuitive handling and understanding of anatomy and might allow for more accurate staging of PDAC and could thus become a valuable adjunct in PDAC resectability assessment in the future.

Keywords: Anatomy; Innovation; Medical training; Pancreatic cancer; Virtual reality.

MeSH terms

Carcinoma, Pancreatic Ductal* / diagnostic imaging
Carcinoma, Pancreatic Ductal* / surgery
Female
Humans
Magnetic Resonance Imaging* / methods
Male
Middle Aged
Pancreatic Neoplasms* / diagnostic imaging
Pancreatic Neoplasms* / surgery
Tomography, X-Ray Computed* / methods
Virtual Reality*

Grants and funding

3MS1054/Universität Basel