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

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– < 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. Results: 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. 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.