Consistent Surgeon Evaluations of Three-Dimensional Rendering of PET/CT Scans of the Abdomen of a Patient with a Ductal Pancreatic Mass

Abstract

Two-dimensional (2D) positron emission tomography (PET) and computed tomography (CT) are used for diagnosis and evaluation of cancer patients, requiring surgeons to look through multiple planar images to comprehend the tumor and surrounding tissues. We hypothesized that experienced surgeons would consistently evaluate three-dimensional (3D) presentation of CT images overlaid with PET images when preparing for a procedure. We recruited six Jefferson surgeons to evaluate the accuracy, usefulness, and applicability of 3D renderings of the organs surrounding a malignant pancreas prior to surgery. PET/CT and contrast-enhanced CT abdominal scans of a patient with a ductal pancreatic mass were segmented into 3D surface renderings, followed by co-registration. Version A used only the PET/CT image, while version B used the contrast-enhanced CT scans co-registered with the PET images. The six surgeons answered 15 questions covering a) the ease of use and accuracy of models, b) how these models, with/without PET, changed their understanding of the tumor, and c) what are the best applications of the 3D visualization, on a scale of 1 to 5. The six evaluations revealed a statistically significant improvement from version A (score 3.6±0.5) to version B (score 4.4±0.4). A paired-samples t-test yielded t(14) = −8.964, p<0.001. Across the surgeon cohort, contrast-enhanced CT fused with PET provided a more lifelike presentation than standard CT, increasing the usefulness of the presentation. The experienced surgeons consistently reported positive reactions to 3D surface renderings of fused PET and contrast-enhanced CT scans of a pancreatic cancer and surrounding organs. Thus, the 3D presentation could be a useful preparative tool for surgeons prior to making the first incision. This result supports proceeding to a larger surgeon cohort, viewing prospective 3D images from multiple types of cancer.

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

“…Independent of their level of experience, surgeons perceived CR as beneficial for the comprehension of vascular anatomy and spatial relationship (highest mean scores). This finding is in line with previous results reporting particularly impressive visualizations of high-density and high-contrast structures such as bones or contrast-enhanced vessels by CR . In addition, these results reflect the substantial contribution of CR visualization to depth perception by complex lighting effects.…”

“…This finding is in line with previous results reporting particularly impressive visualizations of high-density and high-contrast structures such as bones or contrast-enhanced vessels by CR. 2 In addition, these results reflect the substantial contribution of CR visualization to depth perception by complex lighting effects.…”

“…Today, significant advances in the spatial resolution and efficiency of CT and MRI technology have greatly improved the ability to produce photorealistic, 3-D images of human anatomy. 2 These advances have served as the driving force and foundation for an ever-growing body of research and advanced technologies geared toward full realiza-tion and broad implementation of computer-assisted imaging in surgery and surgical planning. 3,4 Although volume rendering is still in wide use for advanced visualization science and industry applications, more recently, cinematic rendering has allowed for a more natural and physically accurate image with improved shape and depth perception.…”

“…Misinterpretation of imaging data corrupts preoperative decision making and the designated surgical approach, which, in turn, may jeopardize patient outcomes. Virtual 3-dimensional (3-D) reconstruction techniques have been developed to overcome this subjective limitation, ultimately facilitating comprehension of patient anatomy . However, conventional volume-rendering techniques provide images of limited quality that do not allow an adequate evaluation of complex intra-abdominal structures, such as the liver.…”

“…Virtual 3-dimensional (3-D) reconstruction techniques have been developed to overcome this subjective limitation, ultimately facilitating comprehension of patient anatomy. [1][2][3] However, conventional volume-rendering techniques provide images of limited quality that do not allow an adequate evaluation of complex intra-abdominal structures, such as the liver. In this regard, a more photorealistic visualization may facilitate image interpretation and improve the comprehension of the surgical anatomy.…”