Enhanced Communication of Tumor Margins Using 3D Scanning and Mapping

The scope of our research is to use 3D scanning and augmented reality technology to improve communication of cancer surgery results among the multidisciplinary cancer care team. More specifically, we're hoping to allow for a surgeon to re-resect cancer more precisely and allow for more precise radiation therapy. In the hospital environment, space is often limited, and finding additional room for extra personnel and equipment can be difficult.

The learning curve on this protocol can also be challenging, especially for those without prior experience in 3D scanning and computer aided design. We've created a 3D scanning and virtual mapping protocol for cancer specimens, providing a permanent visual record to grow alongside written pathology reports. This is a powerful communication tool for the entire cancer care team, and is now being investigated in multidisciplinary tumor board discussions, as well as adjuvant radiation therapy treatment planning.

When a surgical specimen is processed for pathologic analysis, it is often destroyed without any visual documentation. This results in lengthy written pathology reports, and can often lead to challenging clinical scenarios in cases of a close or positive margin. Our research protocol creates a interactive permanent visual record of the resected cancer specimen.

Our protocol offers a novel visual representation of a surgically resected oncologic specimen and a map of how it was processed pathologically. This data previously did not exist, and now allows providers to look back at a specimen for reference, multidisciplinary care discussions, and future treatment planning. To begin, set up the three-legged camera tripod on the flat workstation.

Carefully place the 3D scanning camera into the tripod and angle the camera down toward the workstation at a 60-degree angle. Connect the two-part power cord to an external power source and the back of the camera. Place the scanner turntable one foot in front of the 3D camera and tripod setup.

Using the micro USB cable, connect the turntable to the camera, then connect the camera to the laptop computer with a USB cable. Next, obtain the resected oncologic specimen from the surgical team. Rinse the specimen with water to remove any blood or excess clots from resection and gently pat it dry.

Place the specimen on a flat, clean surface. Using a smartphone camera or digital camera, obtain high-quality 2D images of the anterior surface of the specimen. Flip the specimen over exactly 180 degrees and take a second photograph of the posterior surface.

To begin, set up the 3D scanner for scanning the solid tumor. Place a thin sheet of plastic on the 3D scanner turntable to protect the target points from human tissue. Position the prepared resected oncologic specimen onto the plastic sheet, with the anterior surface facing up.

Now, open the 3D scanner software application on the laptop's desktop. Click on the 3D scanner icon on the right side of the screen and select the New Work button. Using an easy to understand naming convention, create a new folder.

To initiate the texture scanning process, select Texture Scan from the menu and leave the open global markers file section blank. Now, navigate to the left side of the screen and select HDR off. Select the on option for with turntable.

Set a line mode to turntable coded targets, turntable steps to eight, turntable speed to 10, and turntable turns to one turn. Adjust the brightness slider bar to increase exposure on the specimen's darker surfaces. Now, click the triangle play button labeled Start Scan on the right hand toolbar, or press the space bar to start the first round of scanning.

Once initiated, wait for the platform to complete all eight rotations, then rotate the scanned image to inspect for any data captured outside the designated green dots on the screen or for any clear artifacts. If the scan is satisfactory, click on the check mark located on the right side of the edit screen to proceed to the next phase of the scan. In case any artifact is detected, hold down the shift key and use the cursor to encircle the artifact outside the intended scan area.

Watch for a red circle to manifest around the unwanted artifact, then click on the delete data button, marked by a garbage can icon, located on the right hand toolbar. To initiate the manual alignment, press the align button, represented by a puzzle piece icon on the right hand toolbar. Click and drag one set of scan data into each alignment frame.

Place group one in the fixed box and group two in the floated box. Use the right click function to orient the two halves of the scan with one side displaying the specimen's exterior and the other showcasing its interior. Align the two halves so their silhouettes match when superimposed.

Use the middle scroll button on the mouse to zoom in and out on the specimen. Identify three distinct landmarks on each set of scan data visible in both sets, serving as alignment points. To select corresponding alignment points, press shift and left click on the first of three chosen points in each group of data.

After selecting two corresponding points, observe a red dot appearing at the selected positions. Check the alignment result in the larger pane beneath the two halves. If the scan is well aligned, move forward to optimization.

To redo the selection of alignment points, press the control key plus Z to undo previous selections, or click on the X box in the top right corner of each pane. Upon completion, export the model in both 3MF and OBJ file formats. Save the files in the folder created at the start of the scanning process.

To begin, set up the 3D scanner for scanning the solid tumor. Take the resected oncologic specimen and prepare it for scanning. After completing the 3D scan, align the scan to replicate the 3D anatomic specimen and save the files in 3MF and OBJ file formats.

Once the specimen is ready for processing, set up the workstation adjacent to the pathology team member responsible for grossing the specimen. Arrange the laptop, computer, and external mouse at the workstation. Open the computer-aided design software from the laptop desktop to enable virtual annotation of the 3D model.

Click on the import button marked by a plus sign icon and import the previously saved 3MF file of the raw scan. Select the paintbrush tool to set a size range of 15 to 30. Use the color palette to match the software paint colors with the actual ink colors on the specimen to outline the borders of each inked region, then adjust the paintbrush tool to a size setting of 35 to 45, and fill in each inked section with the appropriate color.

Consult with the prosector to verify the accuracy of all inked sides. Note the anatomical orientation of each inked side for inclusion in the key.