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Objective: The present study is to develop a user-centered virtual surgery system called Dr. Liver which has clinical applicability and effectiveness to support liver surgery. Materials and methods: The major functions of Dr. Liver include (1) extraction of the liver, vessels, and tumors from abdominal CT images, (2) estimation of the standard liver volume of a patient, (3) volumetry of the extracted liver, vessels, and tumors, (4) segmentation of the liver based on the portal vein structure, and (5) support of surgery planning. A novel semi-automatic liver extraction algorithm was developed and implemented to Dr. Liver for time efficiency and accuracy of extraction. Dr. Liver was evaluated using MDCT data of three patients and compared to the OsriX system in terms of time and accuracy. Results: Dr. Liver was found significantly better than the OsriX system by showing an average (SD) time of liver extraction = 4.4 (2.4) min and an average difference between the volume of a manually extracted liver and that of the corresponding semi-automatically extracted liver = 4.2 (8.9) ml. Furthermore, various user-friendly features such as a procedural interface of virtual surgery planning were implemented into Dr. Liver for usability. Conclusions: It is concluded that Dr. Liver is a clinically effective tool to support liver surgery planning. More sophisticated features and functions are being developed and implemented to Dr. Liver to provide a surgeon with effective information for rational planning of liver surgery.

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ABSTRACT
1. Introduction
2. Use Scenario
3. Evaluation Methods
4. Results
5. Discussion
Acknowledgements
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UCI(KEPA) : I410-ECN-0101-2013-530-001644148