Introduction
Materials and Methods
Generating 3D Simulation Models with 3D Technology
Training on Evaluating Pancreatic Tumor Resectability
Randomized Grouping
Self-Directed Learning with 3D Models or 2D CT Images
Imaging Test and Questionnaire
Case 1: A 53-year-old woman was admitted with a 1-month history of obstructive jaundice. The level of carbohydrate antigen (CA) 19-9 was elevated up to 1200 U/mL. CT images were showed below. Please answer the following questions: | |||
Case 2: A 69-year-old man was admitted with a half-year history of upper abdominal pain and unintentional weight loss. CT images were showed below. Please answer the following questions: | |||
Questions | Options | ||
Anatomy and diagnosis | 1. Tumor location | ① Head and uncinate of pancreas ② Body of pancreas ③ Tail of pancreas | |
2. Which of the arterial phase images showed the upper bound of the tumor? | Image number: | ||
3. Which of the arterial phase images showed the lower boundary of the tumor? | Image number: | ||
4. Is the tumor margin clear? | ① Yes | ② No | |
5. Is there high possibility of diagnosis of pancreatic cancer? | ①Yes | ② No | |
Tumor staging | 6. Is there evidence of distant metastases in abdomen? | ① Yes | ② No |
7. Is there evidence of bile duct involvement? | ① Yes | ② No | |
8. Is there evidence of lymph node enlargement? | ① Yes | ② No | |
9. Is there evidence of tumor embolism in vein? | ① Yes | ② No | |
Surgery planning | 10. Is there artery variations? | ① Yes | ② No |
11. Which of the following vessels might be involved? | ① Abdominal aorta ② Celiac trunk ③ Splenic artery ④ Common hepatic artery ⑤ Hepatic property artery ⑥ Right hepatic artery ⑦ Left hepatic artery ⑧ Gastroduodenal artery ⑨ Superior mesenteric artery ⑩ Left renal artery ⑪ Right renal artery ⑫ Portal vein ⑬ Superior mesenteric vein ⑭ Inferior mesenteric vein ⑮ Splenic vein ⑯ Inferior vena cava ⑰ Left renal vein ⑱ Right renal vein None of above | ||
12. Is there a high possibility to do the artery/vein reconstruction? | ①Yes | ②No | |
13. Which of the following organs might be involved? | ① Stomach ② Duodenum ③ Colon ④ Spleen ⑤ Small intestine ⑥ Adrenal gland ⑦ Kidney ⑧ None of above | ||
14. What’s your evaluation on tumor resection? | ① Resectable ② Borderline resectable ③ Unresectable |
Questionnaires for surgical training | Feedback results | |||||
---|---|---|---|---|---|---|
Mean scores | p* | |||||
3D | 2D | Mean difference (95% CI) | ||||
Intention to the training | 1. This is the best teaching pattern. | 4.48 ± 0.55 | 4.32 ± 0.64 | 0.16 (− 0.09 to 0.41) | 0.21 | |
2. This teaching pattern is efficient in transferring information. | 4.50 ± 0.51 | 4.34 ± 0.64 | 0.16 (− 0.09 to 0.40) | 0.20 | ||
3. For 3D group: More time should be allocated to 3D models learning. For 2D group: More time should be allocated to CT learning. | 4.80 ± 0.41 | 3.98 ± 0.79 | 0.82 (0.55 to 1.09) | < 0.001 | ||
4. It is necessary to introduce this training into surgical resident program. (This question is only for 3D group) | 4.75 ± 0.49 | / | / | / | ||
Anatomy | 5. This training makes complex anatomy easier. | 4.73 ± 0.45 | 4.20 ± 0.73 | 0.52 (0.26 to 0.78) | < 0.001 | |
6. This training improves understanding of the anatomic relationship between tumors and adjacent tissues. | 4.48 ± 0.51 | 3.86 ± 0.85 | 0.61 (0.32 to 0.91) | < 0.001 | ||
Image reasoning | 7. This training makes it easier to identify the corresponding structures in the cross-sectional CT. | 4.57 ± 0.59 | 4.73 ± 0.54 | − 0.16 (− 0.40 to 0.08) | 0.19 | |
Surgery | 8. This training is beneficial for surgery planning. | 4.55 ± 0.55 | 4.66 ± 0.57 | − 0.11 (− 0.35 to 0.12) | 0.34 | |
9. This training increased your interest in pancreatectomy. | 4.70 ± 0.46 | 4.07 ± 0.76 | 0.64 (0.37 to 0.90) | < 0.001 | ||
Training modes | 10. Choose your favorite learning modes: | / | / | / | / | |
① Self-learning | ② Group learning | |||||
③ Conventional lectures | ④ Other modes |
Statistical Analysis
Ethical Approval
Results
Characteristics of Residents
3D model + CT, n = 44 | 2D CT, n = 44 | p* | ||
---|---|---|---|---|
Years of residency training | 1 | 19 (43) | 20 (45) | 0.967 |
2 | 12 (27) | 11 (25) | ||
3 | 9 (21) | 10 (23) | ||
4 | 4 (9) | 3 (7) | ||
Gender | Male | 38 (86) | 39 (89) | 0.747 |
Female | 6 (14) | 5 (11) | ||
Pancreatic surgery experience, yes | 11(25) | 10(23) | 0.803 |
Scores of the Test
Questions | Test scenario | 3D group n = 44 | 2D group n = 44 | Mean difference (95% CI) | p* |
---|---|---|---|---|---|
Anatomy and diagnosis | Case 1 | 3.91 ± 0.80 | 3.59 ± 0.79 | 0.32 (− 0.02 to 0.65) | 0.06 |
Case 2 | 3.55 ± 0.85 | 3.30 ± 0.73 | 0.25 (− 0.09 to 0.59) | 0.14 | |
Tumor staging | Case 1 | 3.09 ± 0.71 | 2.41 ± 0.76 | 0.68 (0.37 to 0.99) | < 0.001 |
Case 2 | 3.27 ± 0.73 | 2.43 ± 0.62 | 0.84 (0.55 to 1.13) | < 0.001 | |
Surgery planning | Case 1 | 3.36 ± 0.72 | 2.36 ± 0.89 | 1.00 (0.66 to 1.34) | < 0.001 |
Case 2 | 3.39 ± 0.69 | 2.45 ± 0.93 | 0.93 (0.59 to 1.28) | < 0.001 | |
Sum scores | Case 1 | 10.36 ± 1.38 | 8.36 ± 1.42 | 2.00 (1.41 to 2.59) | < 0.001 |
Case 2 | 10.20 ± 1.32 | 8.18 ± 1.24 | 2.02 (1.48 to 2.57) | < 0.001 |