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Toward automatic atlas-based surgical planning for septoplasty

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Surgery for nasal airway obstruction (NAO) has a high failure rate, with up to 50% of patients reporting persistent symptoms postoperatively. Virtual surgery planning has the potential to improve surgical outcomes, but current manual methods are too labor-intensive to be adopted on a large scale. This manuscript introduces an automatic atlas-based approach for performing virtual septoplasties.

Methods

A cohort of 47 healthy subjects and 26 NAO patients was investigated. An atlas of healthy nasal geometry was constructed. The automatic virtual septoplasty method consists of a multi-stage registration approach to fit the atlas to a target NAO patient, automatically segment the patient’s septum and airway, and deform the patient image to have a non-deviated septum.

Results

Our automatic virtual septoplasty method straightened the septum successfully in 18 out of 26 NAO patients (69% of cases). In these cases, the ratio of the higher to the lower airspace cross-sectional areas in the left and right nasal cavities improved from 1.47 ± 0.45 to 1.16 ± 0.33 in the region surrounding the septal deviation, showing that the nasal airway became more symmetric after virtual septoplasty.

Conclusion

This automated virtual septoplasty technique has the potential to greatly reduce the effort required to perform computational fluid dynamics (CFD) analysis of nasal airflow for NAO surgical planning. Future studies are needed to investigate if virtual surgery planning using this method is predictive of subjective symptoms in NAO patients after septoplasty.

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Data availability

The data used in this study are not publicly available.

Code availability

The code used to complete this study is not publicly available but was built upon open-source toolkits, primarily ITK, 3D Slicer, and Elastix. The Elastix configuration files used for the various registration steps are available at [29].

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Funding

This work was supported by NIH R44 EB023121.

Author information

Authors and Affiliations

  1. Kitware, Inc. Medical Computing Group, Carrboro, NC, USA

    Jared Vicory & Andinet Enquobahrie

  2. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA

    Guilherme J. M. Garcia & John S. Rhee

  3. Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, Milwaukee, WI, USA

    Guilherme J. M. Garcia

Authors
  1. Jared Vicory
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  2. Guilherme J. M. Garcia
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  3. John S. Rhee
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  4. Andinet Enquobahrie
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Correspondence to Jared Vicory.

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The authors have no conflicts of interest to declare.

Ethical approval

This study was approved by the Institutional Review Board at the Medical College of Wisconsin.

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Informed consent was obtained from all individuals whose data were used in this study.

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Vicory, J., Garcia, G.J.M., Rhee, J.S. et al. Toward automatic atlas-based surgical planning for septoplasty. Int J CARS 17, 403–411 (2022). https://doi.org/10.1007/s11548-021-02524-9

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  • DOI: https://doi.org/10.1007/s11548-021-02524-9

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