Cross-Professional Evaluation of 3D Visualization of Liver Malignancies in the Decade of AI and Automatic Segmentation: A Benefit for Multidisciplinary Teams and Tumor Board Decisions?

Autor:	Heiliger C; Department of General, Visceral and Transplant Surgery, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, DEU., Andrade D; Department of General, Visceral and Transplant Surgery, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, DEU., Etzel L; Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, DEU., Roessler D; Department of Internal Medicine II - Gastroenterology, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, DEU., Schmidt VF; Department of Radiology, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, DEU., Boesch F; Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen (UMG), Göttingen, DEU., Ricke J; Department of Radiology, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, DEU., Werner J; Department of General, Visceral and Transplant Surgery, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, DEU., Karcz K; Department of General, Visceral and Transplant Surgery, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, DEU., Solyanik O; Department of Radiology, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, DEU.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Oct 24; Vol. 16 (10), pp. e72320. Date of Electronic Publication: 2024 Oct 24 (Print Publication: 2024).
DOI:	10.7759/cureus.72320
Abstrakt:	Purpose To investigate whether automatic 3D visualization of computed tomography (CT) data sets with singular liver tumor compared to 2D images could foster a broader understanding of tumor localization and resectability in the liver within a multidisciplinary team and might therefore be a useful tool in multidisciplinary decision-making. Material and methods The study was configured as a web-based questionnaire. Physicians of all levels of medical training from surgery, radiology, and gastroenterology departments were recruited. A total of seven cases with singular liver tumor CT images with adequate quality were selected. Automatic 3D segmentation was performed using Universal Atlas (Release 5.0) as part of the Brainlab of Elements software suite (Brainlab AG, Munich, Germany). All cases were randomly presented in a 2D and 3D manner. After every case-presentation, multiple choice (single answer) questions concerning tumor extent and resectability were asked. The questions as well as the answers defined to be correct, were evaluated by two senior consultants from the radiology and surgery department. The primary outcome parameters were the correctness of answers stratified for medical specialty and for the level of medical training. The secondary outcome was the time needed for the evaluation of seven liver cases using 2D versus 3D images. Six additional questions were tailored to evaluate the subjective value of the 3D visualization.  Results A total of 92 participants participated in the study, 31.5% of them were abdominal surgeons, 34.8% gastroenterologists, and 33.7% radiologists. Based on the level of medical training, 66 were residents (71.7%) and 26 consultants (28.3%). Only radiologists answered more questions correctly using 2D imaging compared to the 3D method (p = 0.006). There was no statistically significant difference between correctly answered questions when using 2D vs. 3D visualization in the gastroenterologist and surgeon groups (p > 0.05). The resident subgroup showed no statistically significant difference when using the 2D vs. 3D images (p > 0.05), the consultant subgroup answered more questions correctly using 2D imaging (p = 0.009). Physicians with elementary experience of liver pathology also showed no difference in 2D vs. 3D (p = 0.332), physicians with proficient experience of liver pathology answered more questions correctly using 2D imaging (p = 0.010). The median time taken for the evaluation of the seven liver cases was only significantly faster for the gastroenterologist group (p = 0.006) using the 3D analysis (median: 9.1 minutes) than the 2D analysis (median: 10.7 minutes).  Over 80% of the participants found the 3D presentation to be a helpful additional tool for the clinical routine according to the subjective questionnaire. Conclusion In this study 3D visualization of liver tumors was evaluated as helpful within a multidisciplinary team of radiologists, surgeons, and gastroenterologists. However, significantly superior results in the understanding of liver anatomy could not be demonstrated by means of 3D visualization. It may be that more immersive technologies such as augmented reality or virtual reality will lead to a superior understanding compared to conventional presentation of information in 2D cross-sectional images. Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of the Medical Faculty of Ludwig Maximilian University issued approval EK-LMU19-395. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Heiliger et al.)
Databáze:	MEDLINE
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