Neuroradiology ReportEfficacy and reliability of highly functional open source DICOM software (OsiriX) in spine surgery
Introduction
Recent technical advances in spinal surgery have facilitated difficult surgical procedures for patients with severe deformities and for elderly patients with collapsed vertebrae from osteoporosis. These difficult operations require precise anatomical information to be captured preoperatively, which increases the importance of three-dimensional (3D) reconstructed images. However, 3D imaging techniques have several drawbacks, such as their expense, time consumed in printing and reconstructing images, and difficulties in precise communication between doctors and technicians. We have recently been using the freely available Digital Imaging and COmmunication in Medicine (DICOM) software, OsiriX (Antoine Rosset, 2003–2009), as a clinical reference in spine surgery in addition to various other commercial software packages. OsiriX is highly functional DICOM software that allows anyone to reconstruct and manipulate 3D images.[1], [2] However, being free software under a GNU Operating System (Free Software Foundation; Boston, MA, USA) General Public License (GPL), the software is used at one’s own risk and has not yet been approved as medical software.
To our knowledge there are no reports that describe the reliability of OsiriX in spine surgery. We aimed to evaluate the efficacy and reliability of OsiriX software, and provide some information on how to use this software.
Section snippets
Patients and imaging protocol
CT data from 10 patients who underwent cervical spine surgeries at our Institute from 2003 to 2007 were used. The images were examined using a 16-channel multi-detector (MD) CT, Light Speed Ultra 16 (GE Healthcare; Milwaukee, WI, USA) and the slice thickness was 1.25 mm with 0.625-mm intervals (50% overlapping). Images were reconstructed and analyzed on a MacBook Pro 2.16 GHz laptop computer (MA601 J/A with 2 GB random-access memory; Apple; Cupertino, CA, USA), running operating system Mac
Results
When all the images were compared, the 3D reconstructed images from both software packages showed significant consistency. The 3D information was investigated from anterior, posterior, lateral and oblique views, which revealed the reproducibility of the information. For example, 3D images generated by both software packages are presented for comparison (Fig. 1).
The AP and transverse diameters of the spinal canal were measured by OsiriX and Virtual Place software (Table 1). There was no
Discussion
Since the invention of spinal instrumentation and surgical navigation systems, the importance of 3D anatomical information in the surgical field has increased substantially. OsiriX is free DICOM software developed by Rosset et al. at the University of Geneva, that can provide many types of 3D reconstructed images.[1], [2] In particular, VR and MPR images are most useful in preoperative evaluation of disease pathology and for surgical planning. With a sophisticated user interface, not only
Acknowledgements
This work was supported by a Health Labour Science Research Grant of Japan. The authors thank Professor Kazuhisa Takahashi (Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine) for his kind support in the present analysis.
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