What is the clinical evidence from this study?

Study design: Observational. Population: Ablated liver tumors (n=20). Intervention: 3D Slicer software vs. Visual assessment. Primary outcome: Concordance among operators (K Cohen) and image processing time for minimal ablative margin evaluation (K Cohen 0.65-0.74).

What question did this study set out to answer?

The study evaluates the effectiveness of 3D Slicer software for assessing minimal ablative margins in liver tumors post-ablation.

February 28, 2026

Can a Free Open-Source Software Platform Serve as Minimal Ablation Confirmation Assessment Software in Real-Life Practice?

Key Result

3D Slicer software demonstrated substantial inter-reader agreement for minimal ablative margin evaluation (K Cohen 0.65-0.74), but its workflow and time demands limit clinical use.

Key Points

The study evaluates the effectiveness of 3D Slicer software for assessing minimal ablative margins in liver tumors post-ablation.
Retrospective evaluation of 60 ablated liver tumors using pre and post intraprocedural CT images.
Three operators performed assessments: two used 3D Slicer for margin categorization, while one conducted a visual assessment.
Concordance was measured using K Cohen statistics and image processing times for each assessment.
Significant inter-reader agreement found between operators using 3D Slicer (K Cohen 0.65 to 0.74).
No agreement observed between software and visual assessment results (K Cohen -0.30 to 0.11).
Processing time averaged 25 minutes for operator 2 and 49 minutes for operator 3.

Study Design

Type

Observational (n=20)

Structured PICO

Does 3D Slicer software provide reliable minimal ablative margin evaluation compared to visual assessment in patients with ablated liver tumors?

Population

20 patients with 24 ablated liver tumors, median age 64.8 ± 9.7 years, 80% male.

Intervention

Minimal ablative margin (MAM) evaluation using 3D Slicer software with segmentation and registration tools.

Comparator

Visual assessment of the same minimal ablative margins.

Outcome

Concordance among operators (K Cohen) and image processing time for MAMs evaluation.surrogate

While 3D Slicer provides strong inter-reader agreement for evaluating minimal ablative margins in liver tumors, its high time demands and workflow complexity limit its routine clinical utility.

Main Result

Effect estimate: K Cohen 0.65-0.74

Limitations

Insufficient accuracy registration was the main cause of exclusion
Workflow and time demands limit clinical use

Abstract

PURPOSE: The study aims to evaluate the potential of the free open-source general purpose image processing software 3D Slicer for minimal ablative margin (MAM) evaluation. MATERIAL AND METHODS: 3D Slicer was retrospectively applied to assess MAM of ablated liver tumors with pre and post intraprocedural CT. Three operators with different years of experience were involved: two of them assessed the MAMs using 3D Slicers software with the segmentation and registration tools and Model-to-Model extension, and categorized MAM in three categories (≤ 0 mm, > 0- 0- < 5 mm, ≥ 5 mm), with K Cohen between 0.65 and 0.74. Instead, slight or no agreement between software's and visual assessment results was found (K Cohen between - 0.30 and 0.11). Mean time to calculate MAM was respectively of 25' and 16″ for operator 2 and 49' and 26″ for operator 3. CONCLUSION: Strong inter-reader agreement using 3D-Slicer is encouraging, but its workflow and time demands limit clinical use, highlighting the need for task-specific software.

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