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Emerging Intraoperative Imaging Modalities to Improve Surgical Precision

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Abstract

Intraoperative imaging (IOI) is performed to guide delineation and localization of regions of surgical interest. While oncological surgical planning predominantly utilizes x-ray computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US), intraoperative guidance mainly remains on surgeon interpretation and pathology for confirmation. Over the past decades however, intraoperative guidance has evolved significantly with the emergence of several novel imaging technologies, including fluorescence-, Raman, photoacoustic-, and radio-guided approaches. These modalities have demonstrated the potential to further optimize precision in surgical resection and improve clinical outcomes for patients. Not only can these technologies enhance our understanding of the disease, they can also yield large imaging datasets intraoperatively that can be analyzed by deep learning approaches for more rapid and accurate pathological diagnosis. Unfortunately, many of these novel technologies are still under preclinical or early clinical evaluation. Organizations like the Intra-Operative Imaging Study Group of the European Society for Molecular Imaging (ESMI) support interdisciplinary interactions with the aim to improve technical capabilities in the field, an approach that can succeed only if scientists, engineers, and physicians work closely together with industry and regulatory bodies to resolve roadblocks to clinical translation. In this review, we provide an overview of a variety of novel IOI technologies, discuss their challenges, and present future perspectives on the enormous potential of IOI for oncological surgical navigation.

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Acknowledgements

We gratefully thank the European Society for Molecular Imaging for their support and the possibility of establishing a study group for Intraoperative Imaging as a platform for scientific exchange within the society and beyond.

Author information

Author notes

  1. Israt S. Alam and Idan Steinberg contributed equally to this work.

Authors and Affiliations

  1. Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA

    Israt S. Alam, Idan Steinberg, Ophir Vermesh, Sanjiv S. Gambhir & Stephan Rogalla

  2. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Israt S. Alam, Idan Steinberg, Ophir Vermesh, Sanjiv S. Gambhir & Stephan Rogalla

  3. Department of Otolaryngology and Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Nynke S. van den Berg & Eben L. Rosenthal

  4. Surgery, University Medical Center Groningen, Groningen, The Netherlands

    Gooitzen M. van Dam

  5. Department of Nuclear Medicine & Molecular Imaging and Intensive Care, University of Groningen, University Medical Center, Groningen, The Netherlands

    Gooitzen M. van Dam

  6. Institute for Biological and Medical Imaging, Technical University of Munich and Helmholtz Centre Munich, Munich, Germany

    Vasilis Ntziachristos

  7. In Vivo Cellular and Molecular Imaging (ICMI/BEFY), Vrije Universiteit Brussel, Brussels, Belgium

    Sophie Hernot

  8. Department of Medicine, Division of Gastroenterology and Hepatology Stanford University School of Medicine, Stanford, CA, USA

    Stephan Rogalla

  9. Departments of Radiology and Medicine, Molecular Imaging Program at Stanford (MIPS), The James H Clark Center, 318 Campus Drive, East Wing 1st Floor, Stanford, CA, 94305, USA

    Stephan Rogalla

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  1. Israt S. Alam
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  8. Sanjiv S. Gambhir
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All authors wrote, reviewed and approved the manuscript.

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Correspondence to Stephan Rogalla.

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Alam, I.S., Steinberg, I., Vermesh, O. et al. Emerging Intraoperative Imaging Modalities to Improve Surgical Precision. Mol Imaging Biol 20, 705–715 (2018). https://doi.org/10.1007/s11307-018-1227-6

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