Cinematic Rendering - Evaluation Of A New Imaging Technique For Midcab Planning
Arnaud Van Linden1, Tomas Holubec1, Mani Arsalan2, Florian Hecker1, Julius Beckers1, Maik Bittner3, Matthias John3, Serap Van Linden1, Thomas Walther2.
1Kerckhoff Klinik, Bad Nauheim, Germany, 2University Frankfurt, Frankfurt, Germany, 3Siemens Healthineers, Forchheim, Germany.
Objectives: Precise planning of MIDCAB procedures will help finding the perfect approach for mammary artery harvesting and anastomosis site selection. Conventional computed tomography (CT) provides good anatomical information. In addition, cinematic rendering (prototype software, Siemens Healthineers) allows for 3D anatomy-book like visualization of CT-scan datasets. Aim of this preclinical feasibility study, was the evaluation of Cinematic Rendering for MIDCAB planning. Methods: Raw CT-datasets of four patients undergoing MIDCAB surgery were post processed using Cinematic Rendering. The main focus were the visualization of the parasternal LITA course, the epicardial LAD course, the analysis of the LAD stenosis in relation to a potential anastomosis site, and the relation of LITA and anastomosis site and an overall overview of anatomy. Results: Cinematic Rendering post-processing was possible for all four CT-datasets and provided photorealistic images in all patients (Figure 1). The complete LITA course was visualized in all patients. LAD course up to the distal apex was perfectly visualized in 3 patients. One patient had low contrast distal of the stenosis and the distal LAD was visualized dimly. Overall , the 3D visualization of the chest anatomy and the virtual view through the relevant structures supported the planning of the MIDCAB procedure and helped choosing the optimal intercostal space for mammary harvesting and performing the anastomosis. Conclusion: MIDCAB planning using cinematic rendering as a new CT-image post processing tool, is feasible. Detailed and photorealistic visualization of the chest anatomy including LITA and LAD will help the surgeon to choose the optimal intercostal space to perform the procedure. LEGEND Figure 1: Cinematic rendering of CT-scan datasets: A: Visualization of LAD stenosis, B: Visualization of LITA and LAD course and relation, C: Visualization of the heart in the chest. 
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