Consistent surgeon evaluations of three-dimensional rendering of PET/CT scans of the abdomen of a patient with a ductal pancreatic mass

Comparison of Cinematic Rendering and Computed Tomography for Speed and Comprehension of Surgical Anatomy

Question

Does the use of cinematic rendering improve the comprehension of the surgical anatomy?

Findings

In this German preclinical randomized crossover study, visualization with cinematic rendering allowed a more correct and faster comprehension of the surgical anatomy compared with conventional computed tomography independent of the level of surgical experience.

Meaning

Cinematic rendering is a tool that may assist general surgeons with preoperative preparation and intraoperative guidance through an improved interpretation of computed tomography imaging data.

Importance

Three-dimensional (3-D) volume rendering has been shown to improve visualization in general surgery. Cinematic rendering (CR), a novel 3-D visualization technology for postprocessing of computed tomographaphy (CT) images, provides photorealistic images with the potential to improve visualization of anatomic details.

Objective

To determine the value of CR for the comprehension of the surgical anatomy.

Design, Setting, and Participants

This preclinical, randomized, 2-sequence crossover study was conducted from February to November 1, 2018, at University Hospital of Erlangen, Germany. The 40 patient cases were evaluated by 18 resident and attending surgeons using a prepared set of CT and CR images. The patient cases were randomized to 2 assessment sequences (CR-CT and CT-CR). During each assessment period, participants answered 1 question per case that addressed crucial issues of anatomic understanding, preoperative planning, and intraoperative strategies. After a washout period of 2 weeks, case evaluations were crossed over to the respective second image modality.

Main Outcomes and Measures

The primary outcome measure was the correctness of answers. Secondary outcome was the time needed to answer.

Results

The mean (SD) interperiod differences for the percentage of correct answers in the CR-CT sequence (8.5% [7.0%]) differed significantly from those in the CT-CR sequence (−13.1% [6.3%]) (P < .001). The mean (SD) interperiod differences for the time spent to answer the questions in the CR-CT sequence (−18.3 [76.9] seconds) also differed significantly from those in the CT-CR sequence (52.4 [88.5] seconds) (P < .001). Subgroup analysis revealed that residents as well as attending physicians benefitted from CR visualization. Analysis of the case assessment questionnaire showed that CR added significant value to the comprehension of the surgical anatomy (overall mean [SD] score, 4.53 [0.75]). No carryover or period effects were observed.

Conclusions and Relevance

The visualization with CR allowed a more correct and faster comprehension of the surgical anatomy compared with conventional CT imaging, independent of level of surgeon experience. Therefore, CR may assist general surgeons with preoperative preparation and intraoperative guidance.