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Breast conserving surgery re-excision rates are high due to insufficient intraoperative guidance available to the surgeon. Post-operative studies have demonstrated that micro-CT and optical structured light have potential to determine margin status, but typical systems for these modalities are not specifically designed for use in surgical guidance. This study reports on the design and analysis of such a multimodal imaging system and is the first of its kind built specifically for use during breast conserving surgery. The custom system is based on a commercial IVIS SpectrumCT micro-CT scanner (PerkinElmer, Hopkinton, MA) without standard optical and bioluminescence imaging hardware and instead houses multiline lasers (Streamline Lasers, Osela Inc., Lachine, QC, Canada) mounted to a translation stage (DDSM100, Thorlabs, Newton, NJ), and a fast readout CMOS camera (Blackfly S USB 3.0, FLIR, Wilsonville, OR) for reflectance-based optical active line scanning. The system requires minimal training to operate and performs imaging and visualization of scans rapidly. Image processing uses the Insight Toolkit (ITK 5.1.2, Kitware, Clifton Park, NY), CT reconstruction uses the Reconstruction Toolkit (RTK 2.2.0, RTK Consortium, Villeurbanne, France) with CUDA (NVIDIA, Santa Clara, CA) for speed enhancement, and data visualization leverages the Visualization Toolkit (VTK 8.2.0, Kitware, Clifton Park, NY). Resolution and image quality metrics are comparable to current pre-clinical research systems, while scans are performed faster and with streamlined software for interacting with image data in near real-time. This study represents the advancement of multimodal micro-CT and optical structured light imaging toward clinical translation for margin detection during breast conserving surgery.
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