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Journal of Digital Imaging

, Volume 32, Issue 5, pp 761–765 | Cite as

Transcending Dimensions: a Comparative Analysis of Cloaca Imaging in Advancing the Surgeon’s Understanding of Complex Anatomy

  • Alessandra C. GasiorEmail author
  • Carlos Reck
  • Victoria Lane
  • Richard J. Wood
  • Jeremy Patterson
  • Robert Strouse
  • Simon Lin
  • Jennifer Cooper
  • D. Gregory Bates
  • Marc A. Levitt
Article

Abstract

Surgeons have a steep learning capacity to understand 2-D images provided by conventional cloacagrams. Imaging advances now allow for 3-D reconstruction and 3-D models; but no evaluation of the value of these techniques exists in the literature. Therefore, we sought to determine if advances in 3-D imaging would benefit surgeons, lead to accelerated learning, and improve understanding for operative planning of a cloaca reconstruction. Questionnaires were used to assess the understanding of 2-D and 3-D images by pediatric surgical faculty and trainees. For the same case of a cloacal malformation, a 2D contrast study cloacagram, a 3D model rotatable CT scan reconstruction, a software enhanced 3D video animation (which allowed the observer to manipulate the structure in any orientation), and a printed physical 3D cloaca model that could be held in the observer’s hand were employed. Logistic mixed effect models assessed whether the proportion of questions about the case that were answered correctly differed by imaging modality, and whether the proportion answered correctly differed between trainee and attending surgeons for any particular modality. Twenty-nine pediatric surgery trainees (27 pediatric general surgery and 2 pediatric urology surgery trainees) and 30 pediatric surgery and urology faculty participated. For trainees, the percentage of questions answered correctly was: 2-D 10.5%, 3-D PACS 46.7%, 3-D Enhanced 67.1%, and 3-D Printed 73.8%. For faculty, the total percentage of questions answered correctly was: 2-D 22.2%, 3-D PACS 54.8%, 3D Enhanced 66.2%, and 3-D printed 74.0%. The differences in rates of correctness across all four modalities were significant in both fellows and attendings (p < 0.001), with performance being lowest for the 2-D modality, and with increasing percentage of correct answers with each subsequent modality. The difference between trainees and attendings in correctness rate was significant only for the 2-D modality, with attendings answering correctly more often. The 2-D cloacagram, as the least complex model, was the most difficult to interpret. The more complex the modality, the more correct were the responses obtained from both groups. Trainees and attendings had similar levels of correct answers and understanding of the cloacagram for the more advanced modalities. Mental visualization skills of anatomy and complex 3-D spatial arrangements traditionally have taken years of experience to master. Now with novel surgical education resources of a 3-D cloacagram, a more quickly advancing skill is possible.

Keywords

Cloaca 3D printing Surgical education Anorectal malformation 

References

  1. 1.
    Warne S, Chitty LS, Wilcox DT. Prenatal diagnosis of cloacal anomalies. BJU Int 2002 Jan;89(1):78-81.CrossRefGoogle Scholar
  2. 2.
    Levitt MA, Pena A. Pitfalls in the management of newborn cloacas. Pediatr Surg Int. 2005 Apr;21(4):264-9.CrossRefGoogle Scholar
  3. 3.
    Jaramillo D, Lebowitz RL, Hendren WH. The cloacal malformation: radiologic findings and imaging recommendations. Radiology. 1990 Nov;177(2);441-8.CrossRefGoogle Scholar
  4. 4.
    Ventola CL. Medical Applications for 3D Printing: Current and Projected Uses. PT. 2014 Oct;39(10):704-711.Google Scholar
  5. 5.
    Hermsen JL, Burke TM, Seslar SP et al. Scan, plan, print, practice, perform: Development and use of a patient specific 3-dimensional printed model in adult cardiac surgery. J Thorac Cardiovasc Surg. 2016 Aug 20.Google Scholar
  6. 6.
    Kaye R, Goldstein T, Zeltsman D et al. Three dimensional printing: A review on the utility within medicine and otolaryngology. In J Pediatr Otorhinolaryngol. 2016 Oct;89:145-8.CrossRefGoogle Scholar
  7. 7.
    Fujita T, Saito N, Minakata K et al. Transfemoral transcatheter aortic valve implantation in the presence of a mechanical mitral valve prosthesis using a dedicated TAVI guidewire: utility of a patient-specific threedimensional heart model. Cardiovasc Interv Ther. 2016 Aug 27.Google Scholar
  8. 8.
    Valdecasas A, Correas A, Guerrero C et al. Understanding complex systems: lessons from Auzoux’s and von Hagens’s anatomical models. J Biosci 2009;34(6):835-843.CrossRefGoogle Scholar
  9. 9.
    Al-Ramahi J, Luo H, Fang R et al. Development of an Innovative 3D Printed Rigid Bronchoscopy Training Model. Ann Otol Rhinol Laryngol. 2016 Sept 7.Google Scholar
  10. 10.
    Wilasrusmee C, Suvikrom J, Suthakorn J et al. Three-dimensional aortic aneurysm model and endovascular repair: an educational tool for surgical trainees. Wilasrusmee C, Suvikrom J, Lertsithichai P et al. Int J Angiol. 2008 Fall;17(3):129-133.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Deferm S, Meyns B, Vlasselaers D et al. 3-D printing in congenital cardiology: from flatland to spaceland. J Clin Imaging Sci. 2016 Mar 30;6:8.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Society for Imaging Informatics in Medicine 2018

Authors and Affiliations

  • Alessandra C. Gasior
    • 1
    Email author
  • Carlos Reck
    • 1
  • Victoria Lane
    • 1
  • Richard J. Wood
    • 1
  • Jeremy Patterson
    • 2
  • Robert Strouse
    • 2
  • Simon Lin
    • 2
  • Jennifer Cooper
    • 2
  • D. Gregory Bates
    • 1
  • Marc A. Levitt
    • 1
  1. 1.Center for Colorectal and Pelvic ReconstructionNationwide Children’s HospitalColumbusUSA
  2. 2.The Research Institute at Nationwide Children’s HospitalColumbusUSA

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