Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
University of Alberta Hospital, 2A2.41 WMC, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
Int J Comput Assist Radiol Surg. 2023 Oct;18(10):1941-1949. doi: 10.1007/s11548-023-02852-y. Epub 2023 Mar 11.
Typically, preoperative imaging is viewed in two dimensions (2D) only, but three-dimensional (3D) virtual models may improve viewers' anatomical perspective by permitting them to interact with the imaging through manipulating it in space. Research into the utility of these models in most surgical specialties is growing rapidly. This study investigates the utility of 3D virtual models of complex pediatric abdominal tumors for clinical decision making, particularly the decision to proceed with surgical resection or not.
3D virtual models of tumors and adjacent anatomy were created from CT images of pediatric patients scanned for Wilms tumor, neuroblastoma or hepatoblastoma. Pediatric surgeons individually assessed the resectability of the tumors. First, they assessed resectability using the standard protocol of viewing imaging on conventional screens and then reassessed resectability after being presented with the 3D virtual models. Inter-physician agreement on resectability for each patient was analyzed using Krippendorff's alpha. Inter-physician agreement was used as a surrogate for correct interpretation. Participants were also surveyed afterward on the utility and practicality of the 3D virtual models for clinical decision making.
Inter-physician agreement when using CT imaging alone was "fair" (Krippendorff's alpha α = 0.399), while inter-physician agreement when using 3D virtual models increased to "moderate" (Krippendorff's alpha α = 0.532). When surveyed about model utility, all 5 participants considered them helpful. Two participants felt the models would be practical for clinical use in most cases, while 3 felt they would be practical for select cases only.
This study demonstrates the subjective utility of 3D virtual models of pediatric abdominal tumors for clinical decision making. The models are an adjunct that can be particularly useful in complicated tumors that efface or displace critical structures that may impact resectability. Statistical analysis demonstrates the improved inter-rater agreement with the 3D stereoscopic display over the 2D display. The use of 3D displays of medical images will increase over time, and evaluation of their potential usefulness in various clinical settings is necessary.
通常，术前影像学仅以二维（2D）形式呈现，但三维（3D）虚拟模型通过允许使用者在空间中对成像进行操作，从而改善观察者的解剖视角。在大多数外科专业领域，对这些模型的实用性的研究正在迅速发展。本研究调查了用于临床决策的复杂儿科腹部肿瘤的 3D 虚拟模型的实用性，特别是决定是否进行手术切除。
从接受 Wilms 瘤、神经母细胞瘤或肝母细胞瘤扫描的儿科患者的 CT 图像中创建肿瘤和相邻解剖结构的 3D 虚拟模型。小儿外科医生单独评估肿瘤的可切除性。首先，他们使用查看常规屏幕上成像的标准方案评估可切除性，然后在呈现 3D 虚拟模型后重新评估可切除性。使用 Krippendorff 的 alpha 分析每个患者的医生之间在可切除性方面的协议。医生之间的一致性被用作正确解释的替代指标。参与者还在之后对 3D 虚拟模型在临床决策中的实用性和实用性进行了调查。
单独使用 CT 成像时，医生之间的协议为“一般”（Krippendorff 的 alpha α=0.399），而使用 3D 虚拟模型时，医生之间的协议增加到“中等”（Krippendorff 的 alpha α=0.532）。在调查模型的实用性时，所有 5 名参与者都认为它们有帮助。两名参与者认为模型在大多数情况下对临床使用都很实用，而 3 名参与者认为模型仅在某些情况下实用。
本研究证明了儿科腹部肿瘤的 3D 虚拟模型在临床决策中的主观实用性。该模型是一种辅助工具，对于那些使关键结构变形或移位的复杂肿瘤可能影响可切除性的肿瘤特别有用。统计分析表明，与 2D 显示相比，3D 立体显示的评分者间一致性得到了提高。随着时间的推移，对医学图像的 3D 显示的使用将会增加，因此有必要评估它们在各种临床环境中的潜在用途。
