Modern Imaging Guidelines for 3-D Modeling of Pediatric Solid Tumors: A New Era of Surgical Oncology Operative Planning

Background: Three-dimensional (3-D) models are gaining interest for surgical planning in the field of pediatric surgical oncology. The diverse tumor types in pediatric patients and the non-uniform presentation and anatomy make 3D modeling in pediatric oncology particularly challenging. In addition, centers have variability in technique and experience with these approaches. Guidelines for model creation and quality assurance are notably absent. Objective: We developed national recommendations pertaining to image acquisition and model creation for 3-D renderings based on the existing literature and multidisciplinary expertise. Materials and Methods: The literature was critically appraised, and the authors developed minimum standard guidelines for imaging and modeling pediatric solid tumors. Strength of recommendation scores for each guideline were independently determined by the authors. Results: Twelve specific guidelines were developed and scored with overall strength of recommendation ranging from moderate to very strong. Guidelines focused on image acquisition were uniformly scored very strongly while scores for those pertaining to segmentation and model display were slightly less consistent. Conclusions: We propose minimum standards for image acquisition and modern 3-D modeling of pediatric solid tumors based on literature and expertise. The overall level of agreement among our multidisciplinary team was high.