Table 1.
Key statements of the modified Delphi process to define the role of image guidance during surgery
| Item | Level of agreement within clinicians (n=30) | Level of agreement within researchers (n=20) | Level of agreement within industries (n=6) | Overall level of agreement (n=56) |
|---|---|---|---|---|
| Conceptual potential of image-guided surgery | ||||
| 1. Surgical outcomes could be improved by image guided surgery | 94% (28/30) | 95% (19/20) | 100% (6/6) | 95% (53/56) |
| 2. Image guidance will impact on an increasing number of surgeries | 90% (27/30) | 100% (20/20) | 100% (6/6) | 95% (53/56) |
| 3. Image guidance should help to promote minimally invasive surgery and to reduce potential overtreatment | 100% (30/30) | 90% (18/20) | 83% (5/6) | 95% (53/56) |
| 4. Imaging guidance can provide value (can tick multiple answers): | ||||
| - by improving target delineation in order to minimize positive surgical margins | 94% (28/30) | 95% (19/20) | 100% (6/6) | 95% (53/56) |
| - by preserving delicate anatomic structures such as nerves | 97% (29/30) | 100% (20/20) | 100% (6/6) | 98% (55/56) |
| 5. Image guidance should be developed further and integrated in excising surgical procedures | 90% (27/30) | 80% (16/20) | 83% (5/6) | 86% (48/56) |
| Actual clinical value of image-guided surgery | ||||
| 6. Innovations in image guidance should focus on: | ||||
| - realizing a high specificity | 57% (17/30) | 50% (10/20) | 67% (4/6) | 55% (31/56) |
| - realizing a high sensitivity, even when this negatively impacts the specificity | 43% (13/30) | 50% (10/20) | 33% (2/6) | 45% (25/56) |
| 7. Image guided surgery has already proven its value in patient care | 80% (24/30) | 80% (16/20) | 83% (5/6) | 80% (45/56) |
| 8. Today surgical procedures should be revised based on image guidance technologies: | ||||
| - Yes | 67% (20/30) | 45% (9/20) | 33% (2/6) | 55% (31/56) |
| - No | 6% (2/30) | 25% (5/20) | 33% (2/6) | 16% (9/56) |
| - Unable to answer | 27% (8/30) | 30% (6/20) | 33% (2/6) | 29% (16/56) |
| 9. When added to existing surgical procedures, image-guided surgery methods should enhance and not replace routine surgical imaging | 93% (28/30) | 80% (16/20) | 83% (5/6) | 87% (49/56) |
| 10. For lesion targeted procedures to be effective, surgical guidance technologies should target exactly the same lesions as identified at preoperative imaging | 100% (30/30) | 90% (18/20) | 83% (5/6) | 95% (53/56) |
| 11. Image guidance should support identification of local metastases to at least the level provided by preoperative imaging levels | 97% (29/30) | 70% (14/20) | 67% (4/6) | 84% (47/56) |
| 12. Intraoperatively there is a demand for technologies that help identify superficially located (<1 cm beneath the surface) lesions and also deeper lying lesions | 83% (25/30) | 80% (16/20) | 100% (6/6) | 84% (47/56) |
| 13. Which kind of image-guided surgery should we use in daily clinical practice (multiple answers are possible)? | ||||
| - intraoperative ultrasound | 80% (24/30) | 80% (16/20) | 100% (6/6) | 82% (46/56) |
| - radioguidance | 77% (23/30) | 80% (16/20) | 100% (6/6) | 80% (45/46) |
| - fluorescence imaging | 87% (26/30) | 85% (17/20) | 100% (6/6) | 87% (49/56) |
| - 3D printing models | 37% (11/30) | 10% (2/20) | 17% (1/6) | 25% (14/56) |
| - 3D reconstruction | 50% (15/30) | 35% (7/20) | 100% (6/6) | 50% (28/56) |
| - augmented reality | 57% (17/30) | 65% (13/20) | 100% (6/6) | 64% (36/56) |
| 14. Image guidance only has value when it provides directional guidance towards the target in vivo (i.e.: tumour) or around the target in vivo (e.g.: nerves): | ||||
| - Yes | 40% (12/30) | 50% (10/20) | 33% (2/6) | 43% (24/56) |
| - No | 60% (18/30) | 40% (8/20) | 67% (4/6) | 54% (30/56) |
| - Unable to answer | 0/30 | 10% (2/20) | 0/6 | 3% (2/56) |
| 15. Ex vivo back table tissue imaging (imaging of the tissue removed outside the patient) is considered image guided surgery when it influences the surgical procedure | 97% (29/30) | 95% (19/20) | 83% (5/6) | 95% (53/56) |