Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery

Caitlin T. Yeo, Andrew MacDonald, Tamas Ungi, Andras Lasso, Diederick Jalink, Boris Zevin, Gabor Fichtinger, Sulaiman Nanji

Research output: Contribution to journalArticle

Abstract

Objective: A fundamental aspect of surgical planning in liver resections is the identification of key vessel tributaries to preserve healthy liver tissue while fully resecting the tumor(s). Current surgical planning relies primarily on the surgeon's ability to mentally reconstruct 2D computed tomography/magnetic resonance (CT/MR) images into 3D and plan resection margins. This creates significant cognitive load, especially for trainees, as it relies on image interpretation, anatomical and surgical knowledge, experience, and spatial sense. The purpose of this study is to determine if 3D reconstruction of preoperative CT/MR images will assist resident-level trainees in making appropriate operative plans for liver resection surgery. Design: Ten preoperative patient CT/MR images were selected. Images were case-matched, 5 to 2D planning and 5 to 3D planning. Images from the 3D group were segmented to create interactive digital models that the resident can manipulate to view the tumor(s) in relation to landmark hepatic structures. Residents were asked to evaluate the images and devise a surgical resection plan for each image. The resident alternated between 2D and 3D planning, in a randomly generated order. The primary outcome was the accuracy of resident's plan compared to expert opinion. Time to devise each surgical plan was the secondary outcome. Residents completed a prestudy and poststudy questionnaire regarding their experience with liver surgery and the 3D planning software. Setting and Participants: Senior level surgical residents from the Queen's University General Surgery residency program were recruited to participate. Results: A total of 14 residents participated in the study. The median correct response rate was 2 of 5 (40%; range: 0-4) for the 2D group, and 3 of 5 (60%; range: 1-5) for the 3D group (p < 0.01). The average time to complete each plan was 156 ± 107 seconds for the 2D group, and 84 ± 73 seconds for the 3D group (p < 0.01). A total 13 of 14 residents found the 3D model easier to use than the 2D. Most residents noticed a difference between the 2 modalities and found that the 3D model improved their confidence with the surgical plan proposed. Conclusions: The results of this study show that 3D reconstruction for liver surgery planning increases accuracy of resident surgical planning and decreases amount of time required. 3D reconstruction would be a useful model for improving trainee understanding of liver anatomy and surgical resection, and would serve as an adjunct to current 2D planning methods. This has the potential to be developed into a module for teaching liver surgery in a competency-based medical curriculum.

Original languageEnglish (US)
JournalJournal of Surgical Education
DOIs
StateAccepted/In press - 2017
Externally publishedYes

Fingerprint

surgery
reconstruction
Magnetic Resonance Spectroscopy
Tomography
resident
planning
Liver
trainee
Group
Expert Testimony
Internship and Residency
Curriculum
planning methods
Neoplasms
Anatomy
Teaching
Software
experience
confidence
expert

Keywords

  • Computer-assisted surgery
  • Liver surgery
  • Medical education
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Surgical education

ASJC Scopus subject areas

  • Surgery
  • Education

Cite this

Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery. / Yeo, Caitlin T.; MacDonald, Andrew; Ungi, Tamas; Lasso, Andras; Jalink, Diederick; Zevin, Boris; Fichtinger, Gabor; Nanji, Sulaiman.

In: Journal of Surgical Education, 2017.

Research output: Contribution to journalArticle

Yeo, Caitlin T. ; MacDonald, Andrew ; Ungi, Tamas ; Lasso, Andras ; Jalink, Diederick ; Zevin, Boris ; Fichtinger, Gabor ; Nanji, Sulaiman. / Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery. In: Journal of Surgical Education. 2017.
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title = "Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery",
abstract = "Objective: A fundamental aspect of surgical planning in liver resections is the identification of key vessel tributaries to preserve healthy liver tissue while fully resecting the tumor(s). Current surgical planning relies primarily on the surgeon's ability to mentally reconstruct 2D computed tomography/magnetic resonance (CT/MR) images into 3D and plan resection margins. This creates significant cognitive load, especially for trainees, as it relies on image interpretation, anatomical and surgical knowledge, experience, and spatial sense. The purpose of this study is to determine if 3D reconstruction of preoperative CT/MR images will assist resident-level trainees in making appropriate operative plans for liver resection surgery. Design: Ten preoperative patient CT/MR images were selected. Images were case-matched, 5 to 2D planning and 5 to 3D planning. Images from the 3D group were segmented to create interactive digital models that the resident can manipulate to view the tumor(s) in relation to landmark hepatic structures. Residents were asked to evaluate the images and devise a surgical resection plan for each image. The resident alternated between 2D and 3D planning, in a randomly generated order. The primary outcome was the accuracy of resident's plan compared to expert opinion. Time to devise each surgical plan was the secondary outcome. Residents completed a prestudy and poststudy questionnaire regarding their experience with liver surgery and the 3D planning software. Setting and Participants: Senior level surgical residents from the Queen's University General Surgery residency program were recruited to participate. Results: A total of 14 residents participated in the study. The median correct response rate was 2 of 5 (40{\%}; range: 0-4) for the 2D group, and 3 of 5 (60{\%}; range: 1-5) for the 3D group (p < 0.01). The average time to complete each plan was 156 ± 107 seconds for the 2D group, and 84 ± 73 seconds for the 3D group (p < 0.01). A total 13 of 14 residents found the 3D model easier to use than the 2D. Most residents noticed a difference between the 2 modalities and found that the 3D model improved their confidence with the surgical plan proposed. Conclusions: The results of this study show that 3D reconstruction for liver surgery planning increases accuracy of resident surgical planning and decreases amount of time required. 3D reconstruction would be a useful model for improving trainee understanding of liver anatomy and surgical resection, and would serve as an adjunct to current 2D planning methods. This has the potential to be developed into a module for teaching liver surgery in a competency-based medical curriculum.",
keywords = "Computer-assisted surgery, Liver surgery, Medical education, Medical Knowledge, Practice-Based Learning and Improvement, Surgical education",
author = "Yeo, {Caitlin T.} and Andrew MacDonald and Tamas Ungi and Andras Lasso and Diederick Jalink and Boris Zevin and Gabor Fichtinger and Sulaiman Nanji",
year = "2017",
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T1 - Utility of 3D Reconstruction of 2D Liver Computed Tomography/Magnetic Resonance Images as a Surgical Planning Tool for Residents in Liver Resection Surgery

AU - Yeo, Caitlin T.

AU - MacDonald, Andrew

AU - Ungi, Tamas

AU - Lasso, Andras

AU - Jalink, Diederick

AU - Zevin, Boris

AU - Fichtinger, Gabor

AU - Nanji, Sulaiman

PY - 2017

Y1 - 2017

N2 - Objective: A fundamental aspect of surgical planning in liver resections is the identification of key vessel tributaries to preserve healthy liver tissue while fully resecting the tumor(s). Current surgical planning relies primarily on the surgeon's ability to mentally reconstruct 2D computed tomography/magnetic resonance (CT/MR) images into 3D and plan resection margins. This creates significant cognitive load, especially for trainees, as it relies on image interpretation, anatomical and surgical knowledge, experience, and spatial sense. The purpose of this study is to determine if 3D reconstruction of preoperative CT/MR images will assist resident-level trainees in making appropriate operative plans for liver resection surgery. Design: Ten preoperative patient CT/MR images were selected. Images were case-matched, 5 to 2D planning and 5 to 3D planning. Images from the 3D group were segmented to create interactive digital models that the resident can manipulate to view the tumor(s) in relation to landmark hepatic structures. Residents were asked to evaluate the images and devise a surgical resection plan for each image. The resident alternated between 2D and 3D planning, in a randomly generated order. The primary outcome was the accuracy of resident's plan compared to expert opinion. Time to devise each surgical plan was the secondary outcome. Residents completed a prestudy and poststudy questionnaire regarding their experience with liver surgery and the 3D planning software. Setting and Participants: Senior level surgical residents from the Queen's University General Surgery residency program were recruited to participate. Results: A total of 14 residents participated in the study. The median correct response rate was 2 of 5 (40%; range: 0-4) for the 2D group, and 3 of 5 (60%; range: 1-5) for the 3D group (p < 0.01). The average time to complete each plan was 156 ± 107 seconds for the 2D group, and 84 ± 73 seconds for the 3D group (p < 0.01). A total 13 of 14 residents found the 3D model easier to use than the 2D. Most residents noticed a difference between the 2 modalities and found that the 3D model improved their confidence with the surgical plan proposed. Conclusions: The results of this study show that 3D reconstruction for liver surgery planning increases accuracy of resident surgical planning and decreases amount of time required. 3D reconstruction would be a useful model for improving trainee understanding of liver anatomy and surgical resection, and would serve as an adjunct to current 2D planning methods. This has the potential to be developed into a module for teaching liver surgery in a competency-based medical curriculum.

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KW - Medical education

KW - Medical Knowledge

KW - Practice-Based Learning and Improvement

KW - Surgical education

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