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

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. 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– < 5 mm, ≥ 5 mm), while the third operator performed a visual assessment of the same MAMs. Concordance among the three operators (K Cohen) and image processing time for MAMs evaluation was evaluated. Among 60 ablated tumors between April 2023 and January 2024, 24 tumors from 20 patients (median age 64.8 ± 9.7 years, 80% male) were included in the analysis. Insufficient accuracy registration was the main cause of exclusion. Substantial agreement was found between operators using 3D Slicer across all three categories (≤ 0 mm, > 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. 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.