Abstract
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. To determine the value of CR for the comprehension of the surgical anatomy. 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. The primary outcome measure was the correctness of answers. Secondary outcome was the time needed to answer. 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. 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.
Highlights
The visualization with Cinematic rendering (CR) allowed a more correct and faster comprehension of the surgical anatomy compared with conventional computed tomography (CT) imaging, independent of level of surgeon experience
Cinematic Rendering vs Computed Tomography for Speed and Comprehension of Surgical Anatomy
The interpretation of complex anatomy based on conventional crosssectional imaging is difficult and susceptible to errors because it requires advanced spatial reasoning abilities
Summary
Cinematic Rendering: Technical Background Cinematic rendering is a physically based volume-rendering technique. This crossover study used a Monte Carlo pathtracing method to compute the interaction of photons with the scanned patient data.[6] This path-tracing method was first deployed in computer animation programs by the entertainment industry.[7] This rendering method works with data retrieved from conventional CT or magnetic resonance scans. The image quality is determined by the original resolution and increases with the number of light paths that are traced. The use of high-dynamic-range–rendering light maps for illumination and the real-time computation of complex lighting effects produce a photorealistic depiction of the image data (Video 1)
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