Original ReportsDo Three-dimensional Visualization and Three-dimensional Printing Improve Hepatic Segment Anatomy Teaching? A Randomized Controlled Study
Introduction
Hepatic segmental anatomy, first proposed by Claude Couinaud in 1956, is the basis of modern functional and surgical liver anatomy.1, 2, 3 Therefore, good understanding of anatomical structures of hepatic segment is of great importance for medical students. However, the complexity of the hepatic ducts’ distribution makes this subject difficult to master.4
Many tools, such as anatomical atlases and corrosion casts, have been used to teach this anatomy. Among these, three-dimensional visualization (3DV) of computer hepatic segment models is a valuable aide because it vividly details the internal hepatic segments and their structures.5, 6 Crossingham et al.7 used interactive three-dimensional (3D) liver models to help teach trainees the liver’s complex spatial anatomy. Jurgaitis et al.8 further confirmed that computer-generated 3DVs of the liver images could teach clinical hepatic anatomy to medical students more effectively than two-dimensional atlases. However, 3DVs lack many of the haptic qualities of a physical specimen; therefore, they cannot completely replace physical teaching aids.
A feasible way to produce physical hepatic segment models is three-dimensional printing (3DP), or rapid prototyping production, because it can transfer the complex computer models to physical ones through additive production. This technology has been developed over decades and used in the medical field for years.9, 10, 11, 12 For example, physical models of the lung with arteries, veins, and tracheal bronchus, and pulmonary segments have been printed.13 More recently, physical liver models with complex networks of vascular and biliary structures have been printed for preoperative planning in donor liver transplantation.14 But so far, no hepatic segment models have been printed for anatomy teaching, nor have the effects of using such models for education been evaluated.
Therefore, in this study, we aimed to develop a novel 3DP hepatic segment model and evaluate the teaching effectiveness of 3DV and 3DP models compared with that of traditional instruction with anatomical atlases.
Section snippets
3D Reconstructions of Hepatic Structures
A healthy candidate (female, 50-years old) was recruited. After a vascular contrast agent was injected, enhanced computed tomography (CT) scanning was performed with a Brilliance CT 64-channel scanner (Philips, Eindhoven, Netherlands) and compiled into sectional images. Then, 2 experienced radiologists examined the liver dataset to exclude liver disease. The upper abdomen data included 397 sectional images in 0.5-mm intervals with a pixel size of 0.684 mm.
The CT dataset was processed and edited
3DP Hepatic Segment Models
The 3DP model was successfully developed to distinguish the portal and hepatic veins with specific colors and display the hepatic segment structures with partitions clearly. The smallest branches of the model have diameters of approximately 1.4 mm. Hepatic segments and parenchyma morphology could be clearly displayed by the frame structures made of the segmental partitions and the bottom surface of the parenchyma (Fig. 3).
Experts’ Evaluation of the Hepatic Segment Models
All experts agreed or strongly agreed that the models provided good
Discussion
Learning hepatic segment anatomy is difficult and frustrating for medical students and young residents8, 19, 20, 21, 22 because the liver is an extremely complex organ with spatially entwined, branching ducts. Learners often need to refer to anatomy textbooks and two-dimensional atlases to undergo the difficult and inefficient process of creating a mental image of the liver’s stereo structures. A more useful teaching aid could facilitate more efficient and effective learning.
Corrosion casts are
Conclusion
A novel 3DP model that can display the structures of hepatic segments was successfully developed. The 3DV and 3DP models had the same effect on the effectiveness of anatomy education compared with the traditional method using anatomy atlases. However, our study has 2 limitations. Firstly, as the images came from a healthy candidate, the vascular contrast agent could not reach the finer branches, and therefore the diameters in the 3DV and 3DP models were no smaller than 1.4 mm. With a cadaveric
Acknowledgment
61190122 and 61190123 from National Natural Science Foundation of China, China.
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Contributed equally to this work.